Provider Demographics
NPI:1275960387
Name:BELCZAK, SARA E (MS SLP CFY)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:BELCZAK
Suffix:
Gender:F
Credentials:MS SLP CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S MAIN ST
Mailing Address - Street 2:D
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2691
Mailing Address - Country:US
Mailing Address - Phone:630-652-0200
Mailing Address - Fax:630-652-0300
Practice Address - Street 1:310 S MAIN ST
Practice Address - Street 2:D
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2691
Practice Address - Country:US
Practice Address - Phone:630-652-0200
Practice Address - Fax:630-652-0300
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242002537235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist