Provider Demographics
NPI:1467940502
Name:SMITH, SARA ANNE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 20TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6452
Mailing Address - Country:US
Mailing Address - Phone:701-857-4410
Mailing Address - Fax:
Practice Address - Street 1:2855 HIGHWAY 83 NW
Practice Address - Street 2:
Practice Address - City:MAX
Practice Address - State:ND
Practice Address - Zip Code:58759-9458
Practice Address - Country:US
Practice Address - Phone:701-679-2685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty