Provider Demographics
NPI:1124803036
Name:BOTT, SARA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BOTT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1376 FAHLANDER DR N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5106
Mailing Address - Country:US
Mailing Address - Phone:614-441-1000
Mailing Address - Fax:
Practice Address - Street 1:1376 FAHLANDER DR N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5106
Practice Address - Country:US
Practice Address - Phone:614-441-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist