Provider Demographics
NPI:1407263064
Name:BREITHAUPT, SARAH BISSLAND (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:BISSLAND
Last Name:BREITHAUPT
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 1:111 N COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3977
Mailing Address - Country:US
Mailing Address - Phone:630-682-7400
Mailing Address - Fax:
Practice Address - Street 1:640 N. RIVER ROAD SUITE 108
Practice Address - Street 2:FOX VALLEY INSTITUTE
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-718-0717
Practice Address - Fax:630-718-0747
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional