Provider Demographics
NPI:1437174414
Name:THOMSON, SARAH H
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:H
Last Name:THOMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 OTTO LN
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4906
Mailing Address - Country:US
Mailing Address - Phone:847-328-9611
Mailing Address - Fax:
Practice Address - Street 1:3003 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2833
Practice Address - Country:US
Practice Address - Phone:773-508-1110
Practice Address - Fax:773-262-7084
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0102121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK49860Medicare PIN