Provider Demographics
NPI:1912121617
Name:TWEEDY, SARA E (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:TWEEDY
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ELIZABETH
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6421 KATHERINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:MO
Mailing Address - Zip Code:63461-1922
Mailing Address - Country:US
Mailing Address - Phone:573-769-1233
Mailing Address - Fax:
Practice Address - Street 1:1100 CLUB VILLAGE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4409
Practice Address - Country:US
Practice Address - Phone:573-256-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-007121235Z00000X
MO2002027883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist