Provider Demographics
NPI:1538673108
Name:MOWERY, SARA A (MS SLP-CCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:MOWERY
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 N MILWAUKEE AVE APT 2S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2779
Mailing Address - Country:US
Mailing Address - Phone:224-595-3550
Mailing Address - Fax:
Practice Address - Street 1:1514 N MILWAUKEE AVE APT 2S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2779
Practice Address - Country:US
Practice Address - Phone:224-595-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.013014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist