MEDICARE: MS. SARAH EMILY COLEMAN

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	SW2252	FL
2	1041C0700X	Clinical Social Worker	149.028180	IL

General Provider Information

NPI Number	:	1336912914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH EMILY COLEMAN

Provider Business Mailing Address
First Line	:	708 W GRAND AVE CHICAGO
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	708 W GRAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654
Country	:	US
Telephone Number	:	312-300-2190
Fax Number	:

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

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	02/17/2026

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