Provider Demographics
NPI:1306373097
Name:GRIFFIN, SARAH P (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:P
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MARSHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-6255
Mailing Address - Country:US
Mailing Address - Phone:706-975-1175
Mailing Address - Fax:
Practice Address - Street 1:108 MARSHSIDE DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-6255
Practice Address - Country:US
Practice Address - Phone:706-975-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC270405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576000313Medicaid