Provider Demographics
NPI:1275863672
Name:MYERS, SARAH R (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:R
Last Name:MYERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 ADELINE ST STE B
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-3842
Mailing Address - Country:US
Mailing Address - Phone:601-818-1375
Mailing Address - Fax:
Practice Address - Street 1:604 ADELINE ST STE B
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-3842
Practice Address - Country:US
Practice Address - Phone:601-818-1375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist