Provider Demographics
NPI:1134366131
Name:CANGA, SARAH LYNN (LAC, MSOM)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:CANGA
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 STONEGATE RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5600
Mailing Address - Country:US
Mailing Address - Phone:815-893-9825
Mailing Address - Fax:
Practice Address - Street 1:290 STONEGATE RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5600
Practice Address - Country:US
Practice Address - Phone:815-893-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000810171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist