Provider Demographics
NPI:1972792836
Name:IVORY, SARAHANN (MACCCSLP)
Entity Type:Individual
Prefix:
First Name:SARAHANN
Middle Name:
Last Name:IVORY
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W. BRIGANTINE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGANTINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08203
Mailing Address - Country:US
Mailing Address - Phone:484-919-9577
Mailing Address - Fax:
Practice Address - Street 1:308 W BRIGANTINE AVE
Practice Address - Street 2:
Practice Address - City:BRIGANTINE
Practice Address - State:NJ
Practice Address - Zip Code:08203-2544
Practice Address - Country:US
Practice Address - Phone:484-919-9577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00551700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist