Provider Demographics
NPI:1528041019
Name:KEMP, SARA (SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KEMP
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669C WOODLAND SQUARE LP. SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513
Mailing Address - Country:US
Mailing Address - Phone:360-357-3339
Mailing Address - Fax:360-786-1793
Practice Address - Street 1:669 C WOODLAND SQUARE LP. SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513
Practice Address - Country:US
Practice Address - Phone:360-357-3339
Practice Address - Fax:360-786-1793
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAREGENCE ID NUMBEROther1234KE
WA7102320Medicaid