Provider Demographics
NPI:1811038862
Name:ORTH, SARAH JB (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JB
Last Name:ORTH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N VIRGINIA ST
Mailing Address - Street 2:SUITE 245
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3426
Mailing Address - Country:US
Mailing Address - Phone:708-288-2735
Mailing Address - Fax:708-590-3351
Practice Address - Street 1:101 N VIRGINIA ST
Practice Address - Street 2:SUITE 245
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3426
Practice Address - Country:US
Practice Address - Phone:708-288-2735
Practice Address - Fax:708-590-3351
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006358103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632854OtherBCBSIL PPO PROVIDER NUMBE