Provider Demographics
NPI:1073097507
Name:HARRIS, SARA E (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 W MARKET ST APT 305B
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2142
Mailing Address - Country:US
Mailing Address - Phone:567-204-2647
Mailing Address - Fax:
Practice Address - Street 1:2650 W MARKET ST APT 305B
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2142
Practice Address - Country:US
Practice Address - Phone:567-204-2647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8852235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist