Provider Demographics
NPI:1598921611
Name:DUFFY, SARA JANE (BA, MHP)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:JANE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:BA, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 ROUTE 54 W
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-2148
Mailing Address - Country:US
Mailing Address - Phone:217-935-9496
Mailing Address - Fax:217-935-4508
Practice Address - Street 1:1150 ROUTE 54 W
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2148
Practice Address - Country:US
Practice Address - Phone:217-935-9496
Practice Address - Fax:217-935-4508
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program