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NPI Code Detail

MEDICARE: SARAH H THOMSON

MEDICARE: SARAH H THOMSON
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
11041C0700XClinical Social Worker149-010212IL

General Provider Information

NPI Number : 1437174414
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH H THOMSON
Provider Business Mailing Address
First Line : 3209 OTTO LN
Second Line :
City : EVANSTON
State : IL
Zip : 60201-4906
Country : US
Telephone Number : 847-328-9611
Fax Number :
Provider Business Practice Location Address
First Line : 3003 W TOUHY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-2833
Country : US
Telephone Number : 773-508-1110
Fax Number : 773-262-7084
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 05/23/2008

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