Provider Demographics
NPI:1710463682
Name:RIVENBARK, SARA (SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:RIVENBARK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:LANGLOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3526 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8506
Mailing Address - Country:US
Mailing Address - Phone:941-286-4637
Mailing Address - Fax:
Practice Address - Street 1:4620 17TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-1843
Practice Address - Country:US
Practice Address - Phone:941-371-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10804235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist