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General NPI Number Information
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NPI Number | 1598364200
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Entity Type | Individual
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Provider Name | SARAH HAIRSTON
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Gender | Female
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 1 E ERIE ST STE 525
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City | CHICAGO
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State | IL
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Zip | 60611-2980
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Country | US
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Telephone | 312-775-2045
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Fax | 773-938-8512
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Provider Business Mailing Address
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Address Line | 1 E ERIE ST STE 525
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City | CHICAGO
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State | IL
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Zip | 60611-2980
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Country | US
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Telephone | 312-775-2045
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Fax | 773-938-8512
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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 | 150103799
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11991
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License Number State | TN
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