Provider Demographics
NPI:1053801514
Name:FARISON, SARAH KRISTINE (MS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KRISTINE
Last Name:FARISON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KRISTINE
Other - Last Name:MICKSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:506 S GLOVER AVE UNIT E
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-4460
Mailing Address - Country:US
Mailing Address - Phone:847-596-0445
Mailing Address - Fax:
Practice Address - Street 1:1400 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2334
Practice Address - Country:US
Practice Address - Phone:217-337-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist