Provider Demographics
NPI:1023123312
Name:STEVENS, SARAH K (MS, CCC/SLP, DT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:K
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MS, CCC/SLP, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 E SEVEN HILLS LN
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-3728
Mailing Address - Country:US
Mailing Address - Phone:618-392-6283
Mailing Address - Fax:618-615-4201
Practice Address - Street 1:723 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2619
Practice Address - Country:US
Practice Address - Phone:618-393-7732
Practice Address - Fax:618-395-3123
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
IL146006655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8030288OtherBLUECROSS BLUESHIELD IL