Provider Demographics
NPI:1972990273
Name:DOUGLAS, SARAH BRONWEN N
Entity Type:Individual
Prefix:
First Name:SARAH BRONWEN
Middle Name:N
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 TEMPLAR DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2236
Mailing Address - Country:US
Mailing Address - Phone:708-285-2593
Mailing Address - Fax:
Practice Address - Street 1:2024 TEMPLAR DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-2236
Practice Address - Country:US
Practice Address - Phone:708-285-2593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-15-17914103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst