Provider Demographics
NPI:1194097154
Name:SKIDMORE-CROSBY, SARAH R (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:SKIDMORE-CROSBY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-5416
Mailing Address - Country:US
Mailing Address - Phone:912-247-4534
Mailing Address - Fax:
Practice Address - Street 1:116 PENNY LN
Practice Address - Street 2:
Practice Address - City:GUYTON
Practice Address - State:GA
Practice Address - Zip Code:31312-5416
Practice Address - Country:US
Practice Address - Phone:912-247-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006058235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist