Provider Demographics
NPI:1376304394
Name:BRENNAN, SARAH GRACE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GRACE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:GRACE
Other - Last Name:PLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2455 SW STATE ST STE 45&6
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1277
Mailing Address - Country:US
Mailing Address - Phone:515-963-4528
Mailing Address - Fax:
Practice Address - Street 1:2455 SW STATE ST STE 45&6
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1277
Practice Address - Country:US
Practice Address - Phone:515-963-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123590235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist