Provider Demographics
NPI:1619283231
Name:NELSON, SARAH K D (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:K D
Last Name:NELSON
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 1:218 LOUISE LN
Mailing Address - Street 2:
Mailing Address - City:TOANO
Mailing Address - State:VA
Mailing Address - Zip Code:23168-9326
Mailing Address - Country:US
Mailing Address - Phone:757-634-6296
Mailing Address - Fax:
Practice Address - Street 1:6405 BOYDTON PLANK RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-7401
Practice Address - Country:US
Practice Address - Phone:804-861-1324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist