Provider Demographics
NPI:1376770875
Name:SAGE NEUROPSYCHOLOGY CONSULTANTS
Entity Type:Organization
Organization Name:SAGE NEUROPSYCHOLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-434-1264
Mailing Address - Street 1:621 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6709
Mailing Address - Country:US
Mailing Address - Phone:708-288-6718
Mailing Address - Fax:
Practice Address - Street 1:137 N OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1344
Practice Address - Country:US
Practice Address - Phone:708-434-1264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007471261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health