Provider Demographics
NPI:1992010631
Name:GOMEZ, SARA MARIE (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:MARIE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 CHARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5017
Mailing Address - Country:US
Mailing Address - Phone:832-928-5632
Mailing Address - Fax:
Practice Address - Street 1:344 MAIN ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2497
Practice Address - Country:US
Practice Address - Phone:848-200-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102937235Z00000X
NJ41YS00857400235Z00000X
KY293704235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist