Provider Demographics
NPI:1689898058
Name:PREM, SARAH C (MA, CCC SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:C
Last Name:PREM
Suffix:
Gender:F
Credentials:MA, CCC SLP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:C
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:4004 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-4008
Mailing Address - Country:US
Mailing Address - Phone:612-721-2978
Mailing Address - Fax:
Practice Address - Street 1:6 PINE TREE DR STE 330
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-3789
Practice Address - Country:US
Practice Address - Phone:651-639-0942
Practice Address - Fax:651-639-1718
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6456235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist