Provider Demographics
NPI:1104482934
Name:SCRUGGS, SARA N (LCSW)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:N
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-1510
Mailing Address - Country:US
Mailing Address - Phone:630-476-7013
Mailing Address - Fax:
Practice Address - Street 1:28 E MARION ST STE 5
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-2098
Practice Address - Country:US
Practice Address - Phone:815-875-2192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0211551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical