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NPI Code Detail

MEDICARE: MRS. SARAH ELIZABETH JAIN LCSW

MEDICARE: MRS. SARAH ELIZABETH JAIN 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
11041C0700XClinical Social Worker149014077IL
21041C0700XClinical Social Worker34005915AIN
31041C0700XClinical Social Worker6801087443MI

General Provider Information

NPI Number : 1639495583
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SARAH ELIZABETH JAIN LCSW
Provider Business Mailing Address
First Line : 19838 CLARE DR
Second Line :
City : TINLEY PARK
State : IL
Zip : 60487-3581
Country : US
Telephone Number : 815-464-1503
Fax Number :
Provider Business Practice Location Address
First Line : 1800 RAVINIA PL
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-3761
Country : US
Telephone Number : 708-403-7570
Fax Number : 708-403-7546
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2010
Last Update Date : 07/27/2010

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