Healthcare Provider Details

I. General information

NPI: 1154711307
Provider Name (Legal Business Name): SARAH FLETCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W GREENLEAF AVE
CHICAGO IL
60626-2805
US

IV. Provider business mailing address

3009 W BELLE PLAINE AVE #1
CHICAGO IL
60618
US

V. Phone/Fax

Practice location:
  • Phone: 773-382-4054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.015116
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: