Individual
SARAH POTEREK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
1800 NATIONS DR STE 208, GURNEE, IL 60031-9173
(847) 477-9034
(847) 623-8861
Mailing address
1800 NATIONS DR STE 208, GURNEE, IL 60031-9173
(847) 477-9034
(847) 623-8861
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04932271
BLUE SHIELD PROVIDER NUMB
IL
Enumeration date
03/02/2007
Last updated
03/09/2008
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