Provider Demographics
NPI:1215153713
Name:COLLINSWORTH, SARAH SHEA (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:SHEA
Last Name:COLLINSWORTH
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:SHEA
Other - Last Name:LAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 CR 754
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401
Mailing Address - Country:US
Mailing Address - Phone:870-275-5199
Mailing Address - Fax:
Practice Address - Street 1:262 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-275-5199
Practice Address - Fax:870-931-4457
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8026235Z00000X
ARSP#2572235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163423721Medicaid