Provider Demographics
NPI:1063844330
Name:PICKLE, SARA B
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:B
Last Name:PICKLE
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 1:8702 TURNING LEAF
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-6517
Mailing Address - Country:US
Mailing Address - Phone:972-345-1072
Mailing Address - Fax:
Practice Address - Street 1:1485 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-3900
Practice Address - Country:US
Practice Address - Phone:210-432-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist