Provider Demographics
NPI:1003979691
Name:SMITH, SARAH E (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CHINABERRY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2442
Mailing Address - Country:US
Mailing Address - Phone:318-747-9191
Mailing Address - Fax:318-747-6421
Practice Address - Street 1:1000 CHINABERRY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2442
Practice Address - Country:US
Practice Address - Phone:318-747-9191
Practice Address - Fax:318-747-6421
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5157231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1508985Medicaid