Provider Demographics
NPI:1942408372
Name:SHAW, SARAH K (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:K
Last Name:SHAW
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 1:211 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:PA
Mailing Address - Zip Code:18810-1419
Mailing Address - Country:US
Mailing Address - Phone:607-426-9254
Mailing Address - Fax:
Practice Address - Street 1:211 W PINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:PA
Practice Address - Zip Code:18810-1419
Practice Address - Country:US
Practice Address - Phone:607-426-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA00806235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist