Provider Demographics
NPI:1700400736
Name:HOLBROOK, SARAI SOPHIA (CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:SARAI
Middle Name:SOPHIA
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SARAI
Other - Middle Name:SOPHIA
Other - Last Name:DODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:ROOM 038 CPS, 1901 FOURTH AVE.
Mailing Address - Street 2:UW-STEVENS POINT
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ROOM 038 CPS, 1901 FOURTH AVE.
Practice Address - Street 2:UW-STEVENS POINT
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481
Practice Address - Country:US
Practice Address - Phone:715-346-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8743797-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist