Provider Demographics
NPI:1083697767
Name:SMITH, SARAH KOMORNIK (MSP CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:KOMORNIK
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSP CCC SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2222 SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7712
Mailing Address - Country:US
Mailing Address - Phone:803-622-7939
Mailing Address - Fax:803-548-6200
Practice Address - Street 1:2222 SUNSET CIR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7712
Practice Address - Country:US
Practice Address - Phone:803-622-7939
Practice Address - Fax:803-548-6200
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3902235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist