Healthcare Provider Details

I. General information

NPI: 1205740883
Provider Name (Legal Business Name): SARAH DATTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 WAUKEGAN RD STE 115
NORTHFIELD IL
60093-2743
US

IV. Provider business mailing address

3431 N ASHLAND AVE APT 205
CHICAGO IL
60657-0969
US

V. Phone/Fax

Practice location:
  • Phone: 847-201-4278
  • Fax:
Mailing address:
  • Phone: 224-612-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: