Provider Demographics
NPI:1174857338
Name:TICHENOR, SARAH WARNER (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:WARNER
Last Name:TICHENOR
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 1:2166 LAFAYETTE AVE APT E
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2511
Mailing Address - Country:US
Mailing Address - Phone:314-372-5964
Mailing Address - Fax:
Practice Address - Street 1:2166 LAFAYETTE AVE APT E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-2511
Practice Address - Country:US
Practice Address - Phone:314-372-5964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009016954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist