Provider Demographics
NPI:1245569094
Name:FERGUSON, SARAH A
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 MONTGOMERY HWY STE 104
Mailing Address - Street 2:PMB 180
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4900
Mailing Address - Country:US
Mailing Address - Phone:205-516-5132
Mailing Address - Fax:180-022-1089
Practice Address - Street 1:1678 MONTGOMERY HWY STE 104
Practice Address - Street 2:PMB 180
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-4900
Practice Address - Country:US
Practice Address - Phone:205-516-5132
Practice Address - Fax:180-022-1089
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2850235Z00000X
MSS3744235Z00000X
GASLP008748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist