Provider Demographics
NPI:1215183413
Name:POTTER, SARAH (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2631 ROSEHALL LANE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503
Mailing Address - Country:US
Mailing Address - Phone:815-325-8301
Mailing Address - Fax:
Practice Address - Street 1:2631 ROSEHALL LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60503-5686
Practice Address - Country:US
Practice Address - Phone:815-325-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist