Healthcare Provider Details

I. General information

NPI: 1093147647
Provider Name (Legal Business Name): SARAH QUINTON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST SUITE 17-250
CHICAGO IL
60611-5975
US

IV. Provider business mailing address

676 N SAINT CLAIR ST SUITE 1400
CHICAGO IL
60611-2927
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-2620
  • Fax: 312-695-7095
Mailing address:
  • Phone: 312-695-2620
  • Fax: 312-695-7095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.008631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: