Provider Demographics
NPI:1417520347
Name:GROTH, SARA ANNE (MA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE
Last Name:GROTH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 W MCLEAN AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4161
Mailing Address - Country:US
Mailing Address - Phone:708-218-8160
Mailing Address - Fax:
Practice Address - Street 1:2269 N KEDZIE BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2591
Practice Address - Country:US
Practice Address - Phone:312-819-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health