Healthcare Provider Details

I. General information

NPI: 1386214617
Provider Name (Legal Business Name): SARAH RICHARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 08/24/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 RIDGE AVE FL 2
EVANSTON IL
60202-3328
US

IV. Provider business mailing address

2574 MELANIE LN
NORTHBROOK IL
60062-6965
US

V. Phone/Fax

Practice location:
  • Phone: 847-316-6262
  • Fax:
Mailing address:
  • Phone: 847-707-2351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: