Provider Demographics
NPI:1518223890
Name:SHRECKENGOST, SARA ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANN
Last Name:SHRECKENGOST
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 1:411 1/2 WEST MAHONING ST.
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2124
Mailing Address - Country:US
Mailing Address - Phone:814-938-6020
Mailing Address - Fax:
Practice Address - Street 1:411 1/2 WEST MAHONING ST.
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2124
Practice Address - Country:US
Practice Address - Phone:814-938-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009037235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist