MEDICARE: MRS. SARA TILLOTSON M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4148-154	WI
2	235Z00000X	Speech-Language Pathologist	14065880	OH

General Provider Information

NPI Number	:	1366824021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA TILLOTSON M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	1751 FORESTER DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1033
Country	:	US
Telephone Number	:	513-675-0775
Fax Number	:

Provider Business Practice Location Address
First Line	:	11784 HAMILTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-1129
Country	:	US
Telephone Number	:	513-825-2700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2015
Last Update Date	:	10/29/2018

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Directions to “ MRS. SARA TILLOTSON M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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