Provider Demographics
NPI:1922550185
Name:O'BRIEN, SARA M (PHD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:M
Other - Last Name:STASIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:575 N KELLOGG ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-7608
Mailing Address - Country:US
Mailing Address - Phone:309-343-0800
Mailing Address - Fax:309-343-0802
Practice Address - Street 1:575 N KELLOGG ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-7608
Practice Address - Country:US
Practice Address - Phone:309-343-0800
Practice Address - Fax:309-343-0802
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist