Healthcare Provider Details

I. General information

NPI: 1275960387
Provider Name (Legal Business Name): SARA E BELCZAK MS SLP CFY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S MAIN ST D
LOMBARD IL
60148-2691
US

IV. Provider business mailing address

310 S MAIN ST D
LOMBARD IL
60148-2691
US

V. Phone/Fax

Practice location:
  • Phone: 630-652-0200
  • Fax: 630-652-0300
Mailing address:
  • Phone: 630-652-0200
  • Fax: 630-652-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242002537
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: