Provider Demographics
NPI:1700974334
Name:SIEGMUND, SARA JOSEPHINE (AUD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:JOSEPHINE
Last Name:SIEGMUND
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 1:7404 N 1675 EAST RD
Mailing Address - Street 2:
Mailing Address - City:HEYWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:61745-7677
Mailing Address - Country:US
Mailing Address - Phone:309-829-9162
Mailing Address - Fax:
Practice Address - Street 1:207 LANDMARK DR STE A
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3195
Practice Address - Country:US
Practice Address - Phone:309-268-3200
Practice Address - Fax:309-268-3213
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001064237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK09455Medicare ID - Type Unspecified