MEDICARE: SARA MARIE BUIKEMA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.009611	IL

General Provider Information

NPI Number	:	1730890906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA MARIE BUIKEMA LCSW

Provider Business Mailing Address
First Line	:	404 N HIGHLAND AVE
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-2208
Country	:	US
Telephone Number	:	312-479-6599
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 N HIGHLAND AVE
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-2208
Country	:	US
Telephone Number	:	312-479-6599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	12/08/2022

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