Provider Demographics
NPI:1235137399
Name:SHEVLIN, SARAH CARFRAE (MS CCC SLP L)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:CARFRAE
Last Name:SHEVLIN
Suffix:
Gender:F
Credentials:MS 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 1:7807 W GLENLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3804
Mailing Address - Country:US
Mailing Address - Phone:773-680-0942
Mailing Address - Fax:
Practice Address - Street 1:7807 W GLENLAKE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3804
Practice Address - Country:US
Practice Address - Phone:773-680-0942
Practice Address - Fax:773-751-5091
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006382235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01628130OtherBLUE CROSS BLUE SHIELD