Provider Demographics
NPI:1174699474
Name:CONNEMARA, SARA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:CONNEMARA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 E GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-1436
Mailing Address - Country:US
Mailing Address - Phone:414-687-5986
Mailing Address - Fax:
Practice Address - Street 1:1017 W GLEN OAKS LN STE 140
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3371
Practice Address - Country:US
Practice Address - Phone:414-533-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008290235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist