Provider Demographics
NPI:1134463029
Name:SAGAR, KRISTIN TAYLOR (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:TAYLOR
Last Name:SAGAR
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 1:2621 SPRINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-2031
Mailing Address - Country:US
Mailing Address - Phone:336-317-5605
Mailing Address - Fax:336-454-1784
Practice Address - Street 1:2621 SPRINGWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-2031
Practice Address - Country:US
Practice Address - Phone:336-317-5605
Practice Address - Fax:336-454-1784
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8391235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist