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General NPI Number Information
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NPI Number | 1558558346
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Entity Type | Individual
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Provider Name | SARAH ELIZABETH MIES M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 4747 N CANFIELD AVE
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City | NORRIDGE
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State | IL
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Zip | 60706-4480
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Country | US
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Telephone | 708-583-8506
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 W BELLE PLAINE AVE APT 3
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City | CHICAGO
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State | IL
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Zip | 60613-1941
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Country | US
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Telephone | 805-509-1087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP 15217
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.009829
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License Number State | IL
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