Provider Demographics
NPI:1992107320
Name:WILLIAMS, SARA MARIE (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:MARIE
Other - Last Name:DISTEFANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:630 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2170
Mailing Address - Country:US
Mailing Address - Phone:937-283-2565
Mailing Address - Fax:
Practice Address - Street 1:630 W MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2171
Practice Address - Country:US
Practice Address - Phone:937-283-9888
Practice Address - Fax:937-283-2567
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11129231H00000X
OHA.01999231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist