Provider Demographics
NPI:1891124368
Name:WISE, SARAH SEAVERS (AUD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:SEAVERS
Last Name:WISE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 W NORTH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1629
Mailing Address - Country:US
Mailing Address - Phone:708-538-5747
Mailing Address - Fax:708-538-5559
Practice Address - Street 1:675 W NORTH AVE STE 110
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1629
Practice Address - Country:US
Practice Address - Phone:708-538-5747
Practice Address - Fax:708-538-5559
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
IL147001485231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter