Provider Demographics
NPI:1518401561
Name:LANDRY, SARAH MAE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MAE
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MAE
Other - Last Name:WOLFINBARGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5355 W DURNING DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5508
Mailing Address - Country:US
Mailing Address - Phone:208-515-0578
Mailing Address - Fax:
Practice Address - Street 1:5355 W DURNING DR
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5508
Practice Address - Country:US
Practice Address - Phone:208-515-0578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-2915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist