Healthcare Provider Details

I. General information

NPI: 1689539785
Provider Name (Legal Business Name): SARAH AVERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 W 95TH ST STE 101
EVERGREEN PARK IL
60805-2243
US

IV. Provider business mailing address

9045 S ALBANY AVE
EVERGREEN PARK IL
60805-1331
US

V. Phone/Fax

Practice location:
  • Phone: 708-529-3011
  • Fax:
Mailing address:
  • Phone: 708-985-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.022588
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: