Provider Demographics
NPI:1629710843
Name:GREGO, SARA M (LCSW, CADC)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:M
Last Name:GREGO
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:M
Other - Last Name:GREGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SARA M WAITE
Mailing Address - Street 1:1901 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3714
Mailing Address - Country:US
Mailing Address - Phone:312-550-2816
Mailing Address - Fax:
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-550-2816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0206581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical