Provider Demographics
NPI:1205960333
Name:SIEGEL, SANDRA (MA, CCC-A)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:JAFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:880 W CENTRAL RD STE 4300
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2381
Mailing Address - Country:US
Mailing Address - Phone:847-392-2250
Mailing Address - Fax:847-392-2204
Practice Address - Street 1:880 W CENTRAL RD STE 4300
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2381
Practice Address - Country:US
Practice Address - Phone:847-392-2250
Practice Address - Fax:847-392-2204
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000658231H00000X, 231HA2400X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL992240Medicare ID - Type UnspecifiedMEDICARE INDIV. PROV. NO.