Provider Demographics
NPI:1154451136
Name:WASSERBERG, SARAH ANN (MA, CCC SLP L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:WASSERBERG
Suffix:
Gender:F
Credentials:MA, CCC SLP L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-9128
Mailing Address - Country:US
Mailing Address - Phone:630-701-2327
Mailing Address - Fax:630-701-2327
Practice Address - Street 1:643 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-9128
Practice Address - Country:US
Practice Address - Phone:630-701-2327
Practice Address - Fax:630-701-2327
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist