Provider Demographics
NPI:1598733735
Name:ANDERSON KRANTZ, SARAH C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:C
Last Name:ANDERSON KRANTZ
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 1:4940 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2270
Mailing Address - Country:US
Mailing Address - Phone:815-227-0081
Mailing Address - Fax:
Practice Address - Street 1:4940 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2270
Practice Address - Country:US
Practice Address - Phone:815-227-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0108141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q53846Medicare UPIN
ILK21631Medicare PIN