Provider Demographics
NPI:1639407000
Name:OBERG, SARA E (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:OBERG
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75266 ROAD 412
Mailing Address - Street 2:
Mailing Address - City:FARNAM
Mailing Address - State:NE
Mailing Address - Zip Code:69029
Mailing Address - Country:US
Mailing Address - Phone:308-324-1841
Mailing Address - Fax:308-324-1841
Practice Address - Street 1:300 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-2442
Practice Address - Country:US
Practice Address - Phone:308-324-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist