Provider Demographics
NPI:1699392423
Name:SARAH CZOPEK LLC
Entity Type:Organization
Organization Name:SARAH CZOPEK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CZOPEK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC, CATP
Authorized Official - Phone:331-254-4464
Mailing Address - Street 1:2618 MITCHELL DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1608
Mailing Address - Country:US
Mailing Address - Phone:331-254-4464
Mailing Address - Fax:
Practice Address - Street 1:2618 MITCHELL DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1608
Practice Address - Country:US
Practice Address - Phone:331-254-4464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health