MEDICARE: SARAH CUNNINGHAM WATKIN LCSW

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1619175338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH CUNNINGHAM WATKIN LCSW

Provider Business Mailing Address
First Line	:	1655 W SCHOOL ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1043
Country	:	US
Telephone Number	:	312-519-3187
Fax Number	:	773-325-7781

Provider Business Practice Location Address
First Line	:	1655 W SCHOOL ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1043
Country	:	US
Telephone Number	:	312-519-3187
Fax Number	:	773-325-7781

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

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	11/15/2011

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