Provider Demographics
NPI:1891496618
Name:OLIVE AND SAGE WELLNESS
Entity Type:Organization
Organization Name:OLIVE AND SAGE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERLAK
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-722-8038
Mailing Address - Street 1:3304 STILLWELL CT
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1412
Mailing Address - Country:US
Mailing Address - Phone:708-722-8038
Mailing Address - Fax:708-438-5093
Practice Address - Street 1:3304 STILLWELL CT
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1412
Practice Address - Country:US
Practice Address - Phone:708-722-8038
Practice Address - Fax:708-438-5093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty