Healthcare Provider Details

I. General information

NPI: 1184158289
Provider Name (Legal Business Name): SARAH ELIZABETH WURSTER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8711 CIRCLE DR
BROOKFIELD IL
60513-2110
US

IV. Provider business mailing address

8711 CIRCLE DR
BROOKFIELD IL
60513-2110
US

V. Phone/Fax

Practice location:
  • Phone: 708-688-9212
  • Fax:
Mailing address:
  • Phone: 708-688-9212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.010858
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: