Provider Demographics
NPI:1124596044
Name:ACTON, SARA JANE (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:ACTON
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JANE
Other - Last Name:JOHANSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2297 MEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5004
Mailing Address - Country:US
Mailing Address - Phone:734-386-0308
Mailing Address - Fax:
Practice Address - Street 1:3200 W LIBERTY RD STE F
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9180
Practice Address - Country:US
Practice Address - Phone:734-386-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist