Provider Demographics
NPI:1154905487
Name:MASTERS, SARAH VANDEREN (MS)
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:VANDEREN
Last Name:MASTERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 LAMAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502
Mailing Address - Country:US
Mailing Address - Phone:859-321-2298
Mailing Address - Fax:
Practice Address - Street 1:424 LEWIS HARGETT CIR STE B100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3683
Practice Address - Country:US
Practice Address - Phone:430-585-9475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY270332Medicaid