Provider Demographics
NPI:1346889144
Name:BLOMQUIST, SARAH LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:BLOMQUIST
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 1:427 4TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-2088
Mailing Address - Country:US
Mailing Address - Phone:224-875-1975
Mailing Address - Fax:
Practice Address - Street 1:23908 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2122
Practice Address - Country:US
Practice Address - Phone:224-875-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150103809104100000X
IL1490240591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker