MEDICARE: SARAH AHLM

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	149009561	IL

General Provider Information

NPI Number	:	1417330259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH AHLM

Provider Business Mailing Address
First Line	:	332 S MADISON AVE
Second Line	:
City	:	LA GRANGE
State	:	IL
Zip	:	60525-6304
Country	:	US
Telephone Number	:	773-415-1518
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 W ROSCOE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6262
Country	:	US
Telephone Number	:	773-415-1518
Fax Number	:

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

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	06/29/2015

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Directions to “ SARAH AHLM ” Practice Location

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