Provider Demographics
NPI:1699959429
Name:FITCH, SARAH GRACE (AUD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:GRACE
Last Name:FITCH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:GRACE
Other - Last Name:FITCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:310 VILLA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1886
Mailing Address - Country:US
Mailing Address - Phone:503-537-3546
Mailing Address - Fax:
Practice Address - Street 1:310 VILLA RD STE 101
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1886
Practice Address - Country:US
Practice Address - Phone:503-537-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYA-981231H00000X, 231HA2400X, 231HA2500X, 237600000X, 237700000X
OR30792231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500669533Medicaid