Provider Demographics
NPI:1588895775
Name:DAUM, ETTY SARA (MS)
Entity type:Individual
Prefix:MRS
First Name:ETTY
Middle Name:SARA
Last Name:DAUM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-7146
Mailing Address - Country:US
Mailing Address - Phone:732-363-3699
Mailing Address - Fax:
Practice Address - Street 1:400 TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-7146
Practice Address - Country:US
Practice Address - Phone:732-363-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00477900235Z00000X
NY013276-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist