Provider Demographics
NPI:1093216954
Name:STEVENS, SARAH HOLBROOK (HIS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:HOLBROOK
Last Name:STEVENS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 NEW TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7966
Mailing Address - Country:US
Mailing Address - Phone:270-904-0551
Mailing Address - Fax:270-781-9480
Practice Address - Street 1:12315 HANCOCK ST STE 27
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5885
Practice Address - Country:US
Practice Address - Phone:317-688-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY239769237700000X
IN17001575A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist