Provider Demographics
NPI:1083994040
Name:REYNERTSON, SARAH MARGUERITE (LCPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARGUERITE
Last Name:REYNERTSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 SUMMER SAGE CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-2010
Mailing Address - Country:US
Mailing Address - Phone:217-615-2782
Mailing Address - Fax:
Practice Address - Street 1:1210 E MAIN ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-2830
Practice Address - Country:US
Practice Address - Phone:217-615-2782
Practice Address - Fax:217-484-8932
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional