Provider Demographics
NPI:1942794581
Name:LAIRD, SARA ANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:LAIRD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 PINE ST
Mailing Address - Street 2:
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734-2518
Mailing Address - Country:US
Mailing Address - Phone:609-384-1203
Mailing Address - Fax:
Practice Address - Street 1:3 PLAZA DR STE 12
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3765
Practice Address - Country:US
Practice Address - Phone:732-886-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-3076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist