Provider Demographics
NPI:1639243926
Name:RICH, SARA ANN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:ANN
Last Name:RICH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3269 BARWICK RD
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-6031
Mailing Address - Country:US
Mailing Address - Phone:229-560-7292
Mailing Address - Fax:
Practice Address - Street 1:3269 BARWICK RD
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-6031
Practice Address - Country:US
Practice Address - Phone:229-263-5676
Practice Address - Fax:229-263-9067
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2421235Z00000X
GASLP003307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13-4240112OtherEIN