Healthcare Provider Details

I. General information

NPI: 1770877748
Provider Name (Legal Business Name): SARAH HURLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH GROSS LCSW

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 11/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10540 S WESTERN AVE SUITE 312
CHICAGO IL
60643-2536
US

IV. Provider business mailing address

10352 S WHIPPLE ST
CHICAGO IL
60655-2008
US

V. Phone/Fax

Practice location:
  • Phone: 312-399-6584
  • Fax:
Mailing address:
  • Phone: 312-399-6584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.014000
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: