Provider Demographics
NPI:1104107176
Name:MYERS, SARAH GROVE (MSP, SLP-CCC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:GROVE
Last Name:MYERS
Suffix:
Gender:F
Credentials:MSP, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 BULL ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2560
Mailing Address - Country:US
Mailing Address - Phone:803-767-4832
Mailing Address - Fax:
Practice Address - Street 1:1931 BULL ST
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2560
Practice Address - Country:US
Practice Address - Phone:803-767-4832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist