Provider Demographics
NPI:1376552885
Name:ROSENBLOOM, SARAH KATHRYN (PHD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHRYN
Last Name:ROSENBLOOM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 N SHEFFIELD AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5083
Mailing Address - Country:US
Mailing Address - Phone:312-834-3575
Mailing Address - Fax:
Practice Address - Street 1:2835 N SHEFFIELD AVE STE 209
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5083
Practice Address - Country:US
Practice Address - Phone:312-420-5594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006588103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical