Provider Demographics
NPI:1316677651
Name:BRUNS, SARA MARIE (CF-SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:BRUNS
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 PHILOTHEA RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-9757
Mailing Address - Country:US
Mailing Address - Phone:419-852-9397
Mailing Address - Fax:
Practice Address - Street 1:1101 JACKSON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1395
Practice Address - Country:US
Practice Address - Phone:937-547-2319
Practice Address - Fax:937-548-4248
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15326235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist