Provider Demographics
NPI:1245268572
Name:WYNN, SARAH J (MSW, ACSW, LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:WYNN
Suffix:
Gender:F
Credentials:MSW, ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E WASHINGTON ST
Mailing Address - Street 2:SUITE 2901
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2103
Mailing Address - Country:US
Mailing Address - Phone:773-580-7282
Mailing Address - Fax:773-944-0980
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE 2901
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2103
Practice Address - Country:US
Practice Address - Phone:773-580-7282
Practice Address - Fax:773-944-0980
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0023961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical