Provider Demographics
NPI:1407866924
Name:RYERSON, SARA LYNN BROWN (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN BROWN
Last Name:RYERSON
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 1:101 N VIRGINIA ST
Mailing Address - Street 2:STE. 105
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3426
Mailing Address - Country:US
Mailing Address - Phone:815-477-4024
Mailing Address - Fax:815-477-4034
Practice Address - Street 1:101 N VIRGINIA ST
Practice Address - Street 2:STE. 105
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3426
Practice Address - Country:US
Practice Address - Phone:815-477-4024
Practice Address - Fax:815-477-4034
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical