Provider Demographics
NPI:1578896130
Name:ANDERSON, SARAH MEGAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MEGAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20354 FALLINGWATER CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1806
Mailing Address - Country:US
Mailing Address - Phone:815-258-2350
Mailing Address - Fax:
Practice Address - Street 1:10310 ORLAND PKWY STE 201
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5604
Practice Address - Country:US
Practice Address - Phone:708-995-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL071.009645103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245029Medicaid