Provider Demographics
NPI:1528299047
Name:GIBB, SARA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:GIBB
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:PITKIN
Mailing Address - State:CO
Mailing Address - Zip Code:81241-0303
Mailing Address - Country:US
Mailing Address - Phone:970-787-0968
Mailing Address - Fax:
Practice Address - Street 1:234 N MAIN ST STE 1C
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2438
Practice Address - Country:US
Practice Address - Phone:970-641-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15591235Z00000X
MO2009007651235Z00000X
CO0002699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist