Provider Demographics
NPI:1649043688
Name:ELLEFSON, SARA (AUD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:ELLEFSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11649 N PORT WASHINGTON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3459
Mailing Address - Country:US
Mailing Address - Phone:262-241-3144
Mailing Address - Fax:262-241-3186
Practice Address - Street 1:11649 N PORT WASHINGTON RD STE 105
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3459
Practice Address - Country:US
Practice Address - Phone:262-241-3144
Practice Address - Fax:262-241-3186
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1047-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist