Provider Demographics
NPI:1972830883
Name:BANNISTER, SARAH LEE (MACCCSLP)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:LEE
Last Name:BANNISTER
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 1:521 N TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-2629
Mailing Address - Country:US
Mailing Address - Phone:620-380-1561
Mailing Address - Fax:
Practice Address - Street 1:521 N TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-2629
Practice Address - Country:US
Practice Address - Phone:620-380-1561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist