Provider Demographics
NPI:1487372090
Name:DE COCK, SARAH MARIE (SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:DE COCK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3166 CONEFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-1642
Mailing Address - Country:US
Mailing Address - Phone:248-568-6764
Mailing Address - Fax:850-391-4178
Practice Address - Street 1:1808 MEDART DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-3420
Practice Address - Country:US
Practice Address - Phone:407-486-2262
Practice Address - Fax:850-391-4178
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15751235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist