Provider Demographics
NPI:1881030237
Name:BROYLES, SARA BETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BETH
Last Name:BROYLES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31410 W 174TH TER
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-9158
Mailing Address - Country:US
Mailing Address - Phone:913-953-7009
Mailing Address - Fax:620-364-2013
Practice Address - Street 1:31410 W 174TH TER
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-9158
Practice Address - Country:US
Practice Address - Phone:913-953-7009
Practice Address - Fax:620-364-2013
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist