Basic Information
| Provider Information | |||||||||
| NPI: | 1891039202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'BRIEN | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2758 | ||||||||
| Address2: | 4150 KIMBALL AVENUE | ||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507042758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192355390 | ||||||||
| FaxNumber: | 3192355607 | ||||||||
| Practice Location | |||||||||
| Address1: | 1753 W RIDGEWAY AVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507014544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3198335970 | ||||||||
| FaxNumber: | 3198335971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2012 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 00565 | IA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.