Provider Demographics
NPI:1255908307
Name:RICHMILLER, SARAH LOGAN
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LOGAN
Last Name:RICHMILLER
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 1:2213 SARATOGA DR APT 3
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-5698
Mailing Address - Country:US
Mailing Address - Phone:217-440-8482
Mailing Address - Fax:
Practice Address - Street 1:2610 W RICHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-7112
Practice Address - Country:US
Practice Address - Phone:309-323-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health