Provider Demographics
NPI:1396090460
Name:GALLOWAY, SARA A (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 SUNSHINE DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-1849
Mailing Address - Country:US
Mailing Address - Phone:904-342-5984
Mailing Address - Fax:904-342-5984
Practice Address - Street 1:376 SUNSHINE DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-1849
Practice Address - Country:US
Practice Address - Phone:904-342-5984
Practice Address - Fax:904-342-5984
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist