Provider Demographics
NPI:1619209079
Name:STROSAHL, SALLY GAY (LCPC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:GAY
Last Name:STROSAHL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:STROSAHL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:116 S WESTLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4622
Mailing Address - Country:US
Mailing Address - Phone:630-554-1243
Mailing Address - Fax:
Practice Address - Street 1:68 MAIN ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9861
Practice Address - Country:US
Practice Address - Phone:630-554-1243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.003012101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional