MEDICARE: SARAH SMITH

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	104100000X	Social Worker	150101300	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1194197749	OTHER	IL	NPI

General Provider Information

NPI Number	:	1194197749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH SMITH

Provider Business Mailing Address
First Line	:	3543 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3945
Country	:	US
Telephone Number	:	312-504-7567
Fax Number	:	312-448-8574

Provider Business Practice Location Address
First Line	:	3543 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3945
Country	:	US
Telephone Number	:	312-504-7567
Fax Number	:	312-448-8574

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

Provider Enumeration Date	:	10/22/2015
Last Update Date	:	04/13/2022

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Directions to “ SARAH SMITH ” Practice Location

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