Healthcare Provider Details

I. General information

NPI: 1114850989
Provider Name (Legal Business Name): SAUK VALLEY MIND MATTERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 3RD ST
STERLING IL
61081-3504
US

IV. Provider business mailing address

105 W 3RD ST
STERLING IL
61081-3504
US

V. Phone/Fax

Practice location:
  • Phone: 309-281-9584
  • Fax: 815-310-1048
Mailing address:
  • Phone: 309-281-9584
  • Fax: 815-310-1048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. SUSAN MARIE LATHE
Title or Position: PMHNP-BC
Credential: NP
Phone: 130-928-1958