Provider Demographics
NPI:1629492707
Name:SALEM, SARAH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SALEM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 47TH AVE
Mailing Address - Street 2:SUITE 2120
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3013
Mailing Address - Country:US
Mailing Address - Phone:718-593-4121
Mailing Address - Fax:718-268-2646
Practice Address - Street 1:3100 47TH AVE
Practice Address - Street 2:SUITE 2120
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3013
Practice Address - Country:US
Practice Address - Phone:718-593-4121
Practice Address - Fax:718-268-2646
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY025420-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program