Provider Demographics
NPI:1437416435
Name:WEATHERLY, SARAH LYL (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYL
Last Name:WEATHERLY
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 RICHLAND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2636
Mailing Address - Country:US
Mailing Address - Phone:803-253-6223
Mailing Address - Fax:
Practice Address - Street 1:1710 RICHLAND ST
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2636
Practice Address - Country:US
Practice Address - Phone:803-253-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4753235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist