Provider Demographics
NPI:1972838795
Name:BOSSTICK, SARAH ANN (MS)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ANN
Last Name:BOSSTICK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 LUCIA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-5933
Mailing Address - Country:US
Mailing Address - Phone:850-647-2533
Mailing Address - Fax:
Practice Address - Street 1:272 LUCIA AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-5933
Practice Address - Country:US
Practice Address - Phone:850-647-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9698235Z00000X
IN22003099A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist