Provider Demographics
NPI:1538582358
Name:BENNETT, SARAH JEAN
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JEAN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCP
Mailing Address - Street 1:386 N YORK ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2367
Mailing Address - Country:US
Mailing Address - Phone:815-669-0552
Mailing Address - Fax:
Practice Address - Street 1:386 N YORK ST STE 204
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2367
Practice Address - Country:US
Practice Address - Phone:708-628-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional