MEDICARE: MRS. SARA E PHOU LCSW

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	1041C0700X	Clinical Social Worker	149.016462	IL

General Provider Information

NPI Number	:	1184040446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA E PHOU LCSW

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5140 N CALIFORNIA AVE STE 603
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3645
Country	:	US
Telephone Number	:	847-425-6400
Fax Number	:	847-869-0520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2014
Last Update Date	:	01/22/2026

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