Healthcare Provider Details

I. General information

NPI: 1992939250
Provider Name (Legal Business Name): SARAH W KINSINGER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH R WIMBERLY

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 17-250
CHICAGO IL
60611-5962
US

IV. Provider business mailing address

675 NORTH ST. CLAIR ST. GALTER SUITE 17-250
CHICAGO IL
60611-2951
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-5620
  • Fax:
Mailing address:
  • Phone: 312-695-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.007576
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: