Provider Demographics
NPI:1225679020
Name:RIVARD, SARAH LYNNE (RBT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNNE
Last Name:RIVARD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 N MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3300
Mailing Address - Country:US
Mailing Address - Phone:815-573-3919
Mailing Address - Fax:
Practice Address - Street 1:5900 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3300
Practice Address - Country:US
Practice Address - Phone:815-573-3919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-19-100769106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician