Provider Demographics
NPI:1801211941
Name:MOON, SARAH LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LYNN
Last Name:MOON
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 1:11201 N FOX MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:61517-9601
Mailing Address - Country:US
Mailing Address - Phone:309-224-9891
Mailing Address - Fax:
Practice Address - Street 1:216 E CLINTON ST
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:IL
Practice Address - Zip Code:61517-8157
Practice Address - Country:US
Practice Address - Phone:309-446-3366
Practice Address - Fax:309-446-9500
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist