Provider Demographics
NPI:1780125443
Name:MARRS O'DONNELL, SARA MARIE
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:MARIE
Last Name:MARRS O'DONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:MARIE
Other - Last Name:MARRS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1504 TIFFANY CT
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1968
Mailing Address - Country:US
Mailing Address - Phone:815-922-5803
Mailing Address - Fax:
Practice Address - Street 1:205 N MICHIGAN AVE STE 810
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5902
Practice Address - Country:US
Practice Address - Phone:708-653-0318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.011945101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor