Provider Demographics
NPI:1366824021
Name:TILLOTSON, SARA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:TILLOTSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:KNOLLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1751 FORESTER DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-1033
Mailing Address - Country:US
Mailing Address - Phone:513-675-0775
Mailing Address - Fax:
Practice Address - Street 1:11784 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-1129
Practice Address - Country:US
Practice Address - Phone:513-825-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4148-154235Z00000X
OH14065880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist