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General NPI Number Information
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NPI Number | 1245545359
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Entity Type | Organization
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Legal Business Name | SARAH ROSENBLOOM, PHD
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 333 E ONTARIO ST SUITE 4401B
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City | CHICAGO
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State | IL
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Zip | 60611-4804
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Country | US
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Telephone | 312-420-5594
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Fax |
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Provider Business Mailing Address
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Address Line | 333 E ONTARIO ST SUITE 4401B
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City | CHICAGO
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State | IL
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Zip | 60611-4804
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Country | US
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Telephone | 312-420-5594
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. SARAH ROSENBLOOM
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Credential | PHD
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Telephone | 312-420-5594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-006588
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License Number State | IL
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