Provider Demographics
NPI:1689098246
Name:COUSINO, SARAH G (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:G
Last Name:COUSINO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:G
Other - Last Name:COUSINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:600 LOVELAND MADEIRA RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-2703
Mailing Address - Country:US
Mailing Address - Phone:513-697-3057
Mailing Address - Fax:
Practice Address - Street 1:600 LOVELAND MADEIRA RD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-2703
Practice Address - Country:US
Practice Address - Phone:513-697-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.9258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist