Provider Demographics
NPI:1134701816
Name:WEISS, SARA KATE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KATE
Last Name:WEISS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SUNNYDALE WAY
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6119
Mailing Address - Country:US
Mailing Address - Phone:443-933-0808
Mailing Address - Fax:
Practice Address - Street 1:8508 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2354
Practice Address - Country:US
Practice Address - Phone:443-469-3426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist