Provider Demographics
NPI:1073751939
Name:PROVOST, SARAH RACHAEL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:RACHAEL
Last Name:PROVOST
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 1:8 AMANDA CT
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6307
Mailing Address - Country:US
Mailing Address - Phone:518-587-3957
Mailing Address - Fax:
Practice Address - Street 1:8 AMANDA CT
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6307
Practice Address - Country:US
Practice Address - Phone:518-587-3957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008392-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist