Provider Demographics
NPI:1366176497
Name:GODFREY, SARAH KATE (M ED CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATE
Last Name:GODFREY
Suffix:
Gender:F
Credentials:M ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 THREE WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-4778
Mailing Address - Country:US
Mailing Address - Phone:770-459-6533
Mailing Address - Fax:770-462-1260
Practice Address - Street 1:112 THREE WEST PKWY
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-4778
Practice Address - Country:US
Practice Address - Phone:770-459-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist