Healthcare Provider Details

I. General information

NPI: 1265783344
Provider Name (Legal Business Name): SARA L HANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 S ELDORADO RD STE 1
BLOOMINGTON IL
61704-6035
US

IV. Provider business mailing address

816 S ELDORADO RD STE 1
BLOOMINGTON IL
61704-6035
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-8346
  • Fax: 309-662-0479
Mailing address:
  • Phone: 309-662-8346
  • Fax: 309-662-0479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: