Provider Demographics
NPI:1639322480
Name:HOLLIDAY, SARAH FORD (MS/CCC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:FORD
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:MS/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1108
Mailing Address - Country:US
Mailing Address - Phone:304-647-6470
Mailing Address - Fax:
Practice Address - Street 1:202 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1108
Practice Address - Country:US
Practice Address - Phone:304-647-6470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0012129000/480201800Medicaid