Provider Demographics
NPI:1427450931
Name:PREVITE, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:PREVITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WILLOW CREEK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76085-3652
Mailing Address - Country:US
Mailing Address - Phone:817-550-5058
Mailing Address - Fax:866-509-8177
Practice Address - Street 1:150 WILLOW CREEK DR STE 105
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76085-3652
Practice Address - Country:US
Practice Address - Phone:817-550-5058
Practice Address - Fax:866-509-8177
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107757235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341762801Medicaid
TX8ES434OtherBLUE CROSS BLUE SHIELD