Provider Demographics
NPI:1073132726
Name:HUANG, SARA IVA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:IVA
Last Name:HUANG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1441
Mailing Address - Country:US
Mailing Address - Phone:609-553-1080
Mailing Address - Fax:
Practice Address - Street 1:301 W ROYAL AVE
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1441
Practice Address - Country:US
Practice Address - Phone:609-553-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00921600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist