Provider Demographics
NPI:1114759891
Name:BUEKER, SADIE
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:
Last Name:BUEKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 CHAMPAIGN AVE
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-2646
Mailing Address - Country:US
Mailing Address - Phone:844-999-9003
Mailing Address - Fax:
Practice Address - Street 1:2405 CHAMPAIGN AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-2646
Practice Address - Country:US
Practice Address - Phone:844-999-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist