Provider Demographics
NPI:1033344247
Name:BUSH, SARA MAHON (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MAHON
Last Name:BUSH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:VIRGINIA
Other - Last Name:MAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 GREGS CT
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-7503
Mailing Address - Country:US
Mailing Address - Phone:518-306-5966
Mailing Address - Fax:
Practice Address - Street 1:7 GREGS CT
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-7503
Practice Address - Country:US
Practice Address - Phone:518-306-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014780-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist