Provider Demographics
NPI:1376175315
Name:CHANEY, SARAH JO (SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JO
Last Name:CHANEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W BURLINGTON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556
Mailing Address - Country:US
Mailing Address - Phone:641-469-3130
Mailing Address - Fax:641-469-3131
Practice Address - Street 1:402 W BURLINGTON AVE
Practice Address - Street 2:STE 200
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556
Practice Address - Country:US
Practice Address - Phone:641-469-3130
Practice Address - Fax:641-469-3131
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091485235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA091485OtherIA SLP LICENSE