MEDICARE: SARAH FAGGART 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	242.003741	IL

General Provider Information

NPI Number	:	1710352901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH FAGGART SLP

Provider Business Mailing Address
First Line	:	1452 W GRACE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2833
Country	:	US
Telephone Number	:	216-272-7039
Fax Number	:

Provider Business Practice Location Address
First Line	:	1452 W GRACE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2833
Country	:	US
Telephone Number	:	216-272-7039
Fax Number	:

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

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	12/14/2015

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Directions to “ SARAH FAGGART SLP” Practice Location

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