Provider Demographics
NPI:1255685160
Name:RUDOLPH, SARA ANN (AUD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ANN
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7141 N KEDZIE AVE
Mailing Address - Street 2:APT 113
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7141 N KEDZIE AVE
Practice Address - Street 2:APT 113
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2847
Practice Address - Country:US
Practice Address - Phone:773-290-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001442231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist