Provider Demographics
NPI:1376628669
Name:AVERY-BABEL, SARA M (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:AVERY-BABEL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:M
Other - Last Name:AVERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:2385 ARIEL ST N STE B
Mailing Address - Street 2:PATIENT ACCOUNTING
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2248
Mailing Address - Country:US
Mailing Address - Phone:651-773-3208
Mailing Address - Fax:651-783-5612
Practice Address - Street 1:2385 ARIEL ST N STE B
Practice Address - Street 2:PATIENT ACCOUNTING
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2248
Practice Address - Country:US
Practice Address - Phone:651-773-3208
Practice Address - Fax:651-783-5612
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04549235Z00000X
MN8655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist