Provider Demographics
NPI:1265783344
Name:HANLEY, SARA L
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:HANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 S ELDORADO RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-6035
Mailing Address - Country:US
Mailing Address - Phone:309-662-8346
Mailing Address - Fax:309-662-0479
Practice Address - Street 1:816 S ELDORADO RD STE 1
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-6035
Practice Address - Country:US
Practice Address - Phone:309-662-8346
Practice Address - Fax:309-662-0479
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
IL147.001434231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$01Medicaid