Healthcare Provider Details

I. General information

NPI: 1437802055
Provider Name (Legal Business Name): SARA LEDUC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HEALTH SERVICES DR
DEKALB IL
60115-9637
US

IV. Provider business mailing address

11475 STATE ROUTE 23
WATERMAN IL
60556-7167
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-4875
  • Fax:
Mailing address:
  • Phone: 630-337-2528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.017345
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: