Provider Demographics
NPI:1710119839
Name:DEXTER, SARAH LYNNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LYNNE
Last Name:DEXTER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:LYNNE
Other - Last Name:BOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:15654 AUTUMN GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6106
Mailing Address - Country:US
Mailing Address - Phone:937-271-1894
Mailing Address - Fax:352-354-9863
Practice Address - Street 1:15654 AUTUMN GLEN AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6106
Practice Address - Country:US
Practice Address - Phone:937-271-1894
Practice Address - Fax:352-354-9863
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 9084235Z00000X
FLSA15200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist