Provider Demographics
NPI:1194960179
Name:THOMAS, SARAH (MS,CCC-SLP/SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS,CCC-SLP/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5632
Mailing Address - Country:US
Mailing Address - Phone:718-444-3090
Mailing Address - Fax:
Practice Address - Street 1:2075 E 68TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6009
Practice Address - Country:US
Practice Address - Phone:718-968-7866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58-016019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist