MEDICARE: SARAH NONNENMACHER LCPC

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	101YP2500X	Professional Counselor	180.012271	IL

General Provider Information

NPI Number	:	1437717758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH NONNENMACHER LCPC

Provider Business Mailing Address
First Line	:	1535 LAKE COOK RD STE 303
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1452
Country	:	US
Telephone Number	:	847-674-4662
Fax Number	:	847-559-9428

Provider Business Practice Location Address
First Line	:	1535 LAKE COOK RD STE 303
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1452
Country	:	US
Telephone Number	:	847-674-4662
Fax Number	:	847-559-9428

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

Provider Enumeration Date	:	06/01/2019
Last Update Date	:	06/01/2019

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