Provider Demographics
NPI:1861633455
Name:CHARLTON, SARAH PARKER (SLP/MSCCCS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:PARKER
Last Name:CHARLTON
Suffix:
Gender:F
Credentials:SLP/MSCCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 STRAWBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5952
Mailing Address - Country:US
Mailing Address - Phone:207-782-2150
Mailing Address - Fax:207-782-3621
Practice Address - Street 1:72 STRAWBERRY AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5952
Practice Address - Country:US
Practice Address - Phone:207-782-2150
Practice Address - Fax:207-782-3621
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432593499Medicaid