Provider Demographics
NPI:1467931907
Name:THEOBALD, SABRINA MARIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:MARIA
Last Name:THEOBALD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:MARIA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:664 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7284
Mailing Address - Country:US
Mailing Address - Phone:407-697-6068
Mailing Address - Fax:
Practice Address - Street 1:116 HAMILTON CROSSING RD NW
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-4884
Practice Address - Country:US
Practice Address - Phone:770-606-5849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009657235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist