Healthcare Provider Details

I. General information

NPI: 1750914289
Provider Name (Legal Business Name): SARA NASIR KHAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MAIN ST STE D
PARK RIDGE IL
60068-4060
US

IV. Provider business mailing address

5409 HARVARD TER
SKOKIE IL
60077-2751
US

V. Phone/Fax

Practice location:
  • Phone: 847-823-4444
  • Fax:
Mailing address:
  • Phone: 414-349-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: