MEDICARE: SAUK VALLEY MIND MATTERS PC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1114850989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAUK VALLEY MIND MATTERS PC

Provider Business Mailing Address
First Line	:	105 W 3RD ST
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-3504
Country	:	US
Telephone Number	:	309-281-9584
Fax Number	:	815-310-1048

Provider Business Practice Location Address
First Line	:	105 W 3RD ST
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-3504
Country	:	US
Telephone Number	:	309-281-9584
Fax Number	:	815-310-1048

Authorized Official
Title or Position	:	PMHNP-BC
Name	:	MS. SUSAN MARIE LATHE
Credential	:	NP
Telephone Number	:	130-928-1958

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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