Healthcare Provider Details

I. General information

NPI: 1245683085
Provider Name (Legal Business Name): SARAH E GROVE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E CHESTNUT ST
CHICAGO IL
60611-2014
US

IV. Provider business mailing address

126 E. CHESTNUT
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-351-9581
  • Fax:
Mailing address:
  • Phone: --
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: