Provider Demographics
NPI:1003480559
Name:PUVALOWSKI, SARAH RENEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RENEE
Last Name:PUVALOWSKI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36358 GARFIELD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1152
Mailing Address - Country:US
Mailing Address - Phone:989-400-1542
Mailing Address - Fax:
Practice Address - Street 1:36358 GARFIELD RD STE 2
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-1152
Practice Address - Country:US
Practice Address - Phone:586-221-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty