Provider Demographics
NPI:1255698148
Name:LERCH, SARAH R (LCPC)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:R
Last Name:LERCH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 N BOSWORTH AVE
Mailing Address - Street 2:2A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-3351
Mailing Address - Country:US
Mailing Address - Phone:847-207-4398
Mailing Address - Fax:
Practice Address - Street 1:350 S NORTHWEST HWY
Practice Address - Street 2:STE. 300 2B
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4216
Practice Address - Country:US
Practice Address - Phone:847-207-4398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007774101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor