Healthcare Provider Details

I. General information

NPI: 1528566155
Provider Name (Legal Business Name): SARAH WOJDULA M.S.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 REVERE DR STE 120
NORTHBROOK IL
60062-8005
US

IV. Provider business mailing address

661 BRYN MAWR AVE
BARTLETT IL
60103-5834
US

V. Phone/Fax

Practice location:
  • Phone: 847-807-3717
  • Fax:
Mailing address:
  • Phone: 309-444-0967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-28949
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: