Healthcare Provider Details

I. General information

NPI: 1023239043
Provider Name (Legal Business Name): MRS. SARAH KATHLEEN ZIEMBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14615 W FOX CREEK COURT
BRIMFIELD IL
61517-9529
US

IV. Provider business mailing address

14615 W FOX CREEK COURT
BRIMFIELD IL
61517
US

V. Phone/Fax

Practice location:
  • Phone: 309-258-0084
  • Fax:
Mailing address:
  • Phone: 309-258-0084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.006566
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: