Provider Demographics
NPI:1720334758
Name:MITCHINSON, SARA IRENE (MA,CCC-SLP/L)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:IRENE
Last Name:MITCHINSON
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 1:516 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-8338
Mailing Address - Country:US
Mailing Address - Phone:630-365-3548
Mailing Address - Fax:
Practice Address - Street 1:500 COVENTRY LN STE 170
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7592
Practice Address - Country:US
Practice Address - Phone:815-356-2700
Practice Address - Fax:815-356-2709
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004614235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist