Provider Demographics
NPI:1598294407
Name:GEBHARDT, SARAH (PHD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GEBHARDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 W GUNNISON ST APT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2658
Mailing Address - Country:US
Mailing Address - Phone:616-648-2750
Mailing Address - Fax:
Practice Address - Street 1:378 PARK AVE STE 1D
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-2700
Practice Address - Country:US
Practice Address - Phone:847-730-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.0009754103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical