Provider Demographics
NPI:1316275662
Name:SMALLEY, SARAH JAYCE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JAYCE
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JAYCE
Other - Last Name:KOWALCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1900 SILVER CROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9509
Mailing Address - Country:US
Mailing Address - Phone:815-300-7106
Mailing Address - Fax:815-300-7047
Practice Address - Street 1:540 W NORTH ST STE 207
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:IL
Practice Address - Zip Code:60442-8202
Practice Address - Country:US
Practice Address - Phone:815-478-7866
Practice Address - Fax:815-478-7674
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.002862363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant