Provider Demographics
NPI:1205299914
Name:TRASK, SARAH JONES
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JONES
Last Name:TRASK
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 1:808 HANSON CT
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-2848
Mailing Address - Country:US
Mailing Address - Phone:630-707-2375
Mailing Address - Fax:630-454-2366
Practice Address - Street 1:808 HANSON CT
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2848
Practice Address - Country:US
Practice Address - Phone:630-707-2375
Practice Address - Fax:630-454-2366
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-15-20832103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst