Provider Demographics
NPI:1124409891
Name:JACKSON, SARAH R (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3389
Mailing Address - Country:US
Mailing Address - Phone:847-784-6000
Mailing Address - Fax:847-784-6014
Practice Address - Street 1:161 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3389
Practice Address - Country:US
Practice Address - Phone:847-784-6000
Practice Address - Fax:847-784-6014
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
IL149.0141031041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical