Provider Demographics
NPI:1255344826
Name:FLOCK, SARAH E (MA, CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:FLOCK
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5453
Mailing Address - Country:US
Mailing Address - Phone:773-339-4424
Mailing Address - Fax:
Practice Address - Street 1:150 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5453
Practice Address - Country:US
Practice Address - Phone:773-339-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00045322691OtherBLUE CROSS BLUE SHIELD #