Provider Demographics
NPI:1821448564
Name:LICHT, SARAH OBAROWSKI (AUD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:OBAROWSKI
Last Name:LICHT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:NICOLE
Other - Last Name:OBAROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:203 WOODPARK PL
Mailing Address - Street 2:SUITE B-100
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3705
Mailing Address - Country:US
Mailing Address - Phone:770-726-8948
Mailing Address - Fax:
Practice Address - Street 1:203 WOODPARK PL STE B100
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3758
Practice Address - Country:US
Practice Address - Phone:770-726-8948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD004032231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAUD004032OtherGEORGIA LICENSURE BOARD