Provider Demographics
NPI:1790211860
Name:LANDRUM, SARA JEANETTE (CCC MS SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JEANETTE
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:CCC MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10524 ROUGEMONT LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2348
Mailing Address - Country:US
Mailing Address - Phone:772-979-6001
Mailing Address - Fax:
Practice Address - Street 1:222 SULLIVAN TRAIL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-2020
Practice Address - Country:US
Practice Address - Phone:772-979-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist