Provider Demographics
NPI:1699023242
Name:ROBERTS, SARA JANE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LAUREL ST
Mailing Address - Street 2:APT. C3
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2870
Mailing Address - Country:US
Mailing Address - Phone:845-489-0641
Mailing Address - Fax:
Practice Address - Street 1:40 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1535
Practice Address - Country:US
Practice Address - Phone:914-347-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022140-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist