Provider Demographics
NPI:1922476936
Name:LUNDSTROM, SARAH (AUD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:LUNDSTROM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 NOKOMIS AVE S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2417
Mailing Address - Country:US
Mailing Address - Phone:941-488-4980
Mailing Address - Fax:941-316-9317
Practice Address - Street 1:315 NOKOMIS AVE S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2417
Practice Address - Country:US
Practice Address - Phone:941-488-4980
Practice Address - Fax:941-316-9317
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1984231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist