Provider Demographics
NPI:1104081538
Name:BORETZ, SARAH R (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:R
Last Name:BORETZ
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 1:80 CONGRESS ST
Mailing Address - Street 2:106
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3427
Mailing Address - Country:US
Mailing Address - Phone:413-732-0777
Mailing Address - Fax:413-732-0007
Practice Address - Street 1:80 CONGRESS ST
Practice Address - Street 2:106
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3427
Practice Address - Country:US
Practice Address - Phone:413-732-0777
Practice Address - Fax:413-732-0007
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6938235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist