Provider Demographics
NPI:1083381578
Name:MCDONALD, SAGE (LSW)
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 N ABERDEEN ST APT 902
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6071
Mailing Address - Country:US
Mailing Address - Phone:630-273-1150
Mailing Address - Fax:
Practice Address - Street 1:740 N ABERDEEN ST APT 902
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-6071
Practice Address - Country:US
Practice Address - Phone:630-273-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.104640104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker