Provider Demographics
NPI:1376100511
Name:HOLMES, SARAH ELIZABETH ROSEMARY
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH ROSEMARY
Last Name:HOLMES
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 1:7658 SW ALOMA WAY APT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-7938
Mailing Address - Country:US
Mailing Address - Phone:503-729-4579
Mailing Address - Fax:
Practice Address - Street 1:5319 SW WESTGATE DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2411
Practice Address - Country:US
Practice Address - Phone:503-729-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist