Healthcare Provider Details

I. General information

NPI: 1619248580
Provider Name (Legal Business Name): SARAH GOEDJEN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E SCHAUMBURG RD SUITE 106
SCHAUMBURG IL
60194-3550
US

IV. Provider business mailing address

25 E SCHAUMBURG RD SUITE 106
SCHAUMBURG IL
60194-3550
US

V. Phone/Fax

Practice location:
  • Phone: 847-981-3514
  • Fax:
Mailing address:
  • Phone: 847-981-3514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.007890
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178007890
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: