Provider Demographics
NPI:1497833727
Name:SATHER, PAUL R (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:SATHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 DEAN ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1066
Mailing Address - Country:US
Mailing Address - Phone:630-377-1695
Mailing Address - Fax:630-584-2490
Practice Address - Street 1:2210 DEAN ST
Practice Address - Street 2:SUITE I
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1066
Practice Address - Country:US
Practice Address - Phone:630-377-1695
Practice Address - Fax:630-584-2490
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004739103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist