Provider Demographics
NPI:1235658089
Name:GROB, SARAH (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GROB
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 1:107 E PETERSEN CT
Mailing Address - Street 2:
Mailing Address - City:ASHKUM
Mailing Address - State:IL
Mailing Address - Zip Code:60911-7135
Mailing Address - Country:US
Mailing Address - Phone:815-573-2336
Mailing Address - Fax:
Practice Address - Street 1:107 E PETERSEN CT
Practice Address - Street 2:
Practice Address - City:ASHKUM
Practice Address - State:IL
Practice Address - Zip Code:60911-7135
Practice Address - Country:US
Practice Address - Phone:815-573-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist