Provider Demographics
NPI:1023454337
Name:GUBALA, SARA ANN
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:ANN
Last Name:GUBALA
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 1:13836 S JANAS PKWY
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-7404
Mailing Address - Country:US
Mailing Address - Phone:708-715-9350
Mailing Address - Fax:
Practice Address - Street 1:13836 S JANAS PKWY
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-7404
Practice Address - Country:US
Practice Address - Phone:708-715-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst