Provider Demographics
NPI:1376857714
Name:SAUERMILCH, WILLOW (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:WILLOW
Middle Name:
Last Name:SAUERMILCH
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST STOP 6073
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-6073
Mailing Address - Country:US
Mailing Address - Phone:806-743-9037
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:SUITE 2A300
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-6073
Practice Address - Country:US
Practice Address - Phone:806-743-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104350235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist