Provider Demographics
NPI:1447860960
Name:SMAGA, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SMAGA
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 1:7825 BRISTOL PARK DR N
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-8527
Mailing Address - Country:US
Mailing Address - Phone:708-662-0017
Mailing Address - Fax:
Practice Address - Street 1:44 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4402
Practice Address - Country:US
Practice Address - Phone:855-528-8476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-22-61804103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL815400262OtherAUTISM BEHAVIOR THERAPY, INC.