Provider Demographics
NPI:1225410038
Name:BRETZ, SARA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BRETZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:MAIORANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:447 BELLA VIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6717
Mailing Address - Country:US
Mailing Address - Phone:321-961-3489
Mailing Address - Fax:
Practice Address - Street 1:447 BELLA VIDA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6717
Practice Address - Country:US
Practice Address - Phone:321-961-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 13804235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist