Provider Demographics
NPI:1801837059
Name:SHOGREN-HOLCOMB, SARA L (AUD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:SHOGREN-HOLCOMB
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E STURGIS ST STE 8
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-2068
Mailing Address - Country:US
Mailing Address - Phone:989-534-2020
Mailing Address - Fax:989-534-2684
Practice Address - Street 1:1000 E STURGIS ST STE 8
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2068
Practice Address - Country:US
Practice Address - Phone:989-534-2020
Practice Address - Fax:989-534-2684
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000194231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM38010016Medicare ID - Type UnspecifiedIND PROV ID NUMBER