Provider Demographics
NPI:1619332707
Name:GREENFIELD, SARA (MED CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:MED CCC SLP
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:JOLLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED CCC SLP
Mailing Address - Street 1:320 WASHINGTON AVE
Mailing Address - Street 2:UNIT 405
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1865
Mailing Address - Country:US
Mailing Address - Phone:314-517-0223
Mailing Address - Fax:
Practice Address - Street 1:2701 CLARE AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3313
Practice Address - Country:US
Practice Address - Phone:360-377-3915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60593861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist