Provider Demographics
NPI:1235714247
Name:SARA KATE WARREN, CCC-SLP, LLC
Entity Type:Organization
Organization Name:SARA KATE WARREN, CCC-SLP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SARA KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MCD, CCC-SLP
Authorized Official - Phone:318-265-1991
Mailing Address - Street 1:225 LIGHTHOUSE WAY
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078-8404
Mailing Address - Country:US
Mailing Address - Phone:318-265-1991
Mailing Address - Fax:
Practice Address - Street 1:7330 FERN AVE STE 1103
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4989
Practice Address - Country:US
Practice Address - Phone:318-265-1991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty