Healthcare Provider Details

I. General information

NPI: 1023885969
Provider Name (Legal Business Name): SARA IVES-LOUTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 LAKE ST STE 520
OAK PARK IL
60301-1414
US

IV. Provider business mailing address

715 LAKE ST STE 520
OAK PARK IL
60301-1414
US

V. Phone/Fax

Practice location:
  • Phone: 708-675-7233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180015658
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: