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General NPI Number Information
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NPI Number | 1518776558
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Entity Type | Individual
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Provider Name | SARA JEAN TROCCOLI LSW
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Gender | Female
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 2428 CHARTRES ST
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City | LA SALLE
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State | IL
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Zip | 61301-1107
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Country | US
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Telephone | 815-780-8765
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Fax |
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Provider Business Mailing Address
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Address Line | 601 7TH AVE
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City | OTTAWA
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State | IL
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Zip | 61350-4115
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Country | US
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Telephone | 815-883-4599
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 150115812
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License Number State | IL
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