Provider Demographics
NPI:1972175701
Name:LIDDELL, SARAH (LCPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LIDDELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:711 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-0003
Mailing Address - Country:US
Mailing Address - Phone:708-508-2705
Mailing Address - Fax:
Practice Address - Street 1:711 W MONROE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-0003
Practice Address - Country:US
Practice Address - Phone:708-508-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013540101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional