MEDICARE: SARAH ELIZABETH MIES M.A., 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	SP 15217	CA
2	235Z00000X	Speech-Language Pathologist	146.009829	IL

General Provider Information

NPI Number	:	1558558346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELIZABETH MIES M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	1400 W BELLE PLAINE AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1941
Country	:	US
Telephone Number	:	805-509-1087
Fax Number	:

Provider Business Practice Location Address
First Line	:	4747 N CANFIELD AVE
Second Line	:
City	:	NORRIDGE
State	:	IL
Zip	:	60706-4480
Country	:	US
Telephone Number	:	708-583-8506
Fax Number	:

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

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	09/14/2021

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Directions to “ SARAH ELIZABETH MIES M.A., CCC-SLP” Practice Location

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