Provider Demographics
NPI:1114122686
Name:HICKEY, SARA M (MS, CCC-SLP/ L)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:M
Last Name:HICKEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP/ L
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:M
Other - Last Name:HICKEY CARROLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP/ L
Mailing Address - Street 1:706 N SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:VILLA GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61956-9709
Mailing Address - Country:US
Mailing Address - Phone:217-520-3428
Mailing Address - Fax:
Practice Address - Street 1:706 N SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:VILLA GROVE
Practice Address - State:IL
Practice Address - Zip Code:61956-9709
Practice Address - Country:US
Practice Address - Phone:217-520-3428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist