Provider Demographics
NPI:1053665562
Name:THOMPSON, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OLD WINTHROP RD
Mailing Address - Street 2:APT 206
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 OLD WINTHROP RD
Practice Address - Street 2:APT 206
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4946
Practice Address - Country:US
Practice Address - Phone:802-249-0143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST2225235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist