Provider Demographics
NPI:1104049360
Name:LINDBERG, SALLY SUE (MA)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:SUE
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 W ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-5333
Mailing Address - Country:US
Mailing Address - Phone:773-761-5328
Mailing Address - Fax:
Practice Address - Street 1:5209 N CLARK ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2101
Practice Address - Country:US
Practice Address - Phone:773-761-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health