Healthcare Provider Details

I. General information

NPI: 1710352901
Provider Name (Legal Business Name): SARAH FAGGART SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 W GRACE ST
CHICAGO IL
60613-2833
US

IV. Provider business mailing address

1452 W GRACE ST
CHICAGO IL
60613-2833
US

V. Phone/Fax

Practice location:
  • Phone: 216-272-7039
  • Fax:
Mailing address:
  • Phone: 216-272-7039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.003741
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: