Provider Demographics
NPI:1710499694
Name:KNUDSEN, SARAH A (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:KNUDSEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 HIGH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3688
Mailing Address - Country:US
Mailing Address - Phone:541-342-1980
Mailing Address - Fax:541-342-6207
Practice Address - Street 1:1158 HIGH ST STE 102
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3688
Practice Address - Country:US
Practice Address - Phone:541-342-1980
Practice Address - Fax:541-342-6207
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist