Provider Demographics
NPI:1659393015
Name:SAGO, JILL SUZANNE (BA, MED, MHR)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SUZANNE
Last Name:SAGO
Suffix:
Gender:F
Credentials:BA, MED, MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:BARNSDALL
Mailing Address - State:OK
Mailing Address - Zip Code:74002
Mailing Address - Country:US
Mailing Address - Phone:918-847-3527
Mailing Address - Fax:
Practice Address - Street 1:401 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:BARNSDALL
Practice Address - State:OK
Practice Address - Zip Code:74002
Practice Address - Country:US
Practice Address - Phone:918-847-3527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health