Provider Demographics
NPI:1639129083
Name:VALENZUELA, SARAH (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:VALENZUELA
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 1:213 DERBYSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3994
Mailing Address - Country:US
Mailing Address - Phone:843-365-9458
Mailing Address - Fax:
Practice Address - Street 1:2540 HIGHWAY 501 E
Practice Address - Street 2:
Practice Address - City:AYNOR
Practice Address - State:SC
Practice Address - Zip Code:29511-3477
Practice Address - Country:US
Practice Address - Phone:843-358-1457
Practice Address - Fax:843-358-1458
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5120235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist