Provider Demographics
NPI:1750449583
Name:SPRAGUE, SARAH VAUGHN (MA,CCC,SLP)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:VAUGHN
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:MA,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:PO BOX 196177
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32719-6177
Mailing Address - Country:US
Mailing Address - Phone:407-920-6018
Mailing Address - Fax:407-327-0668
Practice Address - Street 1:774 SENECA MEADOWS RD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4722
Practice Address - Country:US
Practice Address - Phone:407-920-6018
Practice Address - Fax:407-327-0668
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3284235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist