Provider Demographics
NPI:1992014724
Name:WALLENS, SARAH E (MA)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:E
Last Name:WALLENS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 N MAGNOLIA AVE # 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3801
Mailing Address - Country:US
Mailing Address - Phone:312-339-0079
Mailing Address - Fax:
Practice Address - Street 1:3723 N MAGNOLIA AVE # 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3801
Practice Address - Country:US
Practice Address - Phone:312-339-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.001667235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist