Provider Demographics
NPI:1073838603
Name:HYDE, SARAH GUTH (SLP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:GUTH
Last Name:HYDE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 N BAYOUWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-3309
Mailing Address - Country:US
Mailing Address - Phone:337-304-8159
Mailing Address - Fax:
Practice Address - Street 1:1211 N BAYOUWOOD CT
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-3309
Practice Address - Country:US
Practice Address - Phone:337-304-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5843235Z00000X
KY165986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100380150Medicaid