Provider Demographics
NPI:1740210467
Name:EXSTED, SARA BREANNA (SLP CCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BREANNA
Last Name:EXSTED
Suffix:
Gender:F
Credentials:SLP CCC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:KRAEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1009 GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-8747
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4010 W 65TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1721
Practice Address - Country:US
Practice Address - Phone:952-285-2840
Practice Address - Fax:952-285-2830
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist