Provider Demographics
NPI:1174073795
Name:LYDON, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LYDON
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 1:2043 W. BELMONT AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6796
Mailing Address - Country:US
Mailing Address - Phone:773-332-9439
Mailing Address - Fax:773-348-2073
Practice Address - Street 1:2043 W BELMONT AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6796
Practice Address - Country:US
Practice Address - Phone:773-332-9439
Practice Address - Fax:773-348-2073
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist