Provider Demographics
NPI:1659130318
Name:SARA DEBOER
Entity Type:Organization
Organization Name:SARA DEBOER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBOER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, TSSLD
Authorized Official - Phone:516-650-0192
Mailing Address - Street 1:1407 STONY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2214
Mailing Address - Country:US
Mailing Address - Phone:516-650-0192
Mailing Address - Fax:
Practice Address - Street 1:1407 STONY BROOK RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2214
Practice Address - Country:US
Practice Address - Phone:516-650-0192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency