MEDICARE: SORANITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114566171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SORANITY

Provider Business Mailing Address
First Line	:	485 FOXBOROUGH TRL
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4835
Country	:	US
Telephone Number	:	708-308-0453
Fax Number	:

Provider Business Practice Location Address
First Line	:	5202 WASHINGTON ST STE 9-11
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-4772
Country	:	US
Telephone Number	:	708-308-0453
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAYAL SUD
Credential	:	LCSW
Telephone Number	:	708-308-0453

Provider Enumeration Date	:	12/22/2019
Last Update Date	:	12/22/2019

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Directions to “SORANITY ” Practice Location

Language	Start Address	Practice Location

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