Provider Demographics
NPI:1730424532
Name:VILLAGRANA, SARA VENTURA
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:VENTURA
Last Name:VILLAGRANA
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 1:1971 W EVERGREEN AVE
Mailing Address - Street 2:APT 2R
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1934
Mailing Address - Country:US
Mailing Address - Phone:760-470-0278
Mailing Address - Fax:
Practice Address - Street 1:30 E HURON ST
Practice Address - Street 2:UNIT 1106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2766
Practice Address - Country:US
Practice Address - Phone:847-997-7157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103KOOOOOX103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst