Provider Demographics
NPI:1568835908
Name:GILLETTE, SARA (MA SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2656
Mailing Address - Country:US
Mailing Address - Phone:740-454-9747
Mailing Address - Fax:
Practice Address - Street 1:1020 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2656
Practice Address - Country:US
Practice Address - Phone:740-454-9747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2016103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist