Provider Demographics
NPI:1558776526
Name:MEAD, SARA JANE
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:JANE
Last Name:MEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-9396
Mailing Address - Country:US
Mailing Address - Phone:574-773-7733
Mailing Address - Fax:574-773-7133
Practice Address - Street 1:2521 E MARKET ST
Practice Address - Street 2:
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-9396
Practice Address - Country:US
Practice Address - Phone:574-773-7733
Practice Address - Fax:574-773-7133
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46002540A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist