Healthcare Provider Details

I. General information

NPI: 1205527058
Provider Name (Legal Business Name): SARA COTHERN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N MAIN ST
DECATUR IL
62523-1206
US

IV. Provider business mailing address

151 N MAIN ST
DECATUR IL
62523-1206
US

V. Phone/Fax

Practice location:
  • Phone: 217-362-6262
  • Fax: 217-362-6290
Mailing address:
  • Phone: 217-362-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-22337
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: