Provider Demographics
NPI:1053551390
Name:SHAPIRO, SARA (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 N BELL AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3811
Mailing Address - Country:US
Mailing Address - Phone:513-578-2926
Mailing Address - Fax:
Practice Address - Street 1:3712 N BROADWAY ST
Practice Address - Street 2:SUITE 250
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4235
Practice Address - Country:US
Practice Address - Phone:312-458-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009996235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist