Provider Demographics
NPI:1679312508
Name:GOSSETT, SARAH CLAUDETTE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CLAUDETTE
Last Name:GOSSETT
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 1:215 PRIVATE ROAD 2595
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:AR
Mailing Address - Zip Code:72846-9420
Mailing Address - Country:US
Mailing Address - Phone:901-896-6858
Mailing Address - Fax:
Practice Address - Street 1:1811 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:AR
Practice Address - Zip Code:72933-9254
Practice Address - Country:US
Practice Address - Phone:901-896-6858
Practice Address - Fax:479-662-4766
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR203045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR337908721Medicaid