Provider Demographics
NPI:1578716957
Name:KITCHEN, SARA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KITCHEN
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 1:3696 NORTH ST
Mailing Address - Street 2:PO BOX 22
Mailing Address - City:MADISON
Mailing Address - State:NY
Mailing Address - Zip Code:13402
Mailing Address - Country:US
Mailing Address - Phone:704-431-3530
Mailing Address - Fax:
Practice Address - Street 1:174 BAY LAUREL DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-7187
Practice Address - Country:US
Practice Address - Phone:704-301-2683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015523-1235Z00000X
NC9059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist