Provider Demographics
NPI:1235714213
Name:KAHLENBERG, SARA KUBICA
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:KUBICA
Last Name:KAHLENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 PERSIMMON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1385
Mailing Address - Country:US
Mailing Address - Phone:773-454-4724
Mailing Address - Fax:
Practice Address - Street 1:635 PERSIMMON DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1385
Practice Address - Country:US
Practice Address - Phone:773-454-4724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency