Provider Demographics
NPI:1023210952
Name:WELLWOOD, SARAH L (AUD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:WELLWOOD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WALLACE BASHAW WAY
Mailing Address - Street 2:SUITE 3002
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3875
Mailing Address - Country:US
Mailing Address - Phone:978-997-1550
Mailing Address - Fax:
Practice Address - Street 1:1 WALLACE BASHAW WAY
Practice Address - Street 2:SUITE 3002
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3875
Practice Address - Country:US
Practice Address - Phone:978-997-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22965231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist