Provider Demographics
NPI:1376152975
Name:VITZTHUM, SARAH E (LCPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:VITZTHUM
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:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-0768
Mailing Address - Country:US
Mailing Address - Phone:815-844-6109
Mailing Address - Fax:815-844-3561
Practice Address - Street 1:920 W CUSTER AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1067
Practice Address - Country:US
Practice Address - Phone:815-844-6109
Practice Address - Fax:815-844-3561
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional