Provider Demographics
NPI:1992868822
Name:ADAMS, SARA A (SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:ADAMS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 BASSWOOD BLVD
Mailing Address - Street 2:221
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4477
Mailing Address - Country:US
Mailing Address - Phone:817-514-6333
Mailing Address - Fax:817-514-6334
Practice Address - Street 1:5411 BASSWOOD BLVD
Practice Address - Street 2:221
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4477
Practice Address - Country:US
Practice Address - Phone:817-514-6333
Practice Address - Fax:817-514-6334
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181079801Medicaid