Provider Demographics
NPI:1083051338
Name:COFFELT, SARA JAN (MA-SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JAN
Last Name:COFFELT
Suffix:
Gender:F
Credentials:MA-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 E COPPER CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-1740
Mailing Address - Country:US
Mailing Address - Phone:559-433-7976
Mailing Address - Fax:
Practice Address - Street 1:1822 E COPPER CT
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-1740
Practice Address - Country:US
Practice Address - Phone:559-433-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20267OtherSPEECH LANGUAGE PATHOLOGY LICENSE