Provider Demographics
NPI:1336802248
Name:BERNACKI, SARAH CROSBY (AUD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CROSBY
Last Name:BERNACKI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SUTTON RD S STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8439
Mailing Address - Country:US
Mailing Address - Phone:803-547-3800
Mailing Address - Fax:
Practice Address - Street 1:601 SUTTON RD S STE 201
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8439
Practice Address - Country:US
Practice Address - Phone:803-547-3800
Practice Address - Fax:803-547-3803
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4208231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist