Provider Demographics
NPI:1992841191
Name:WILSON, SARAH PLUMB (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:PLUMB
Last Name:WILSON
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 1:12012 DEACONS CROFT LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2561
Mailing Address - Country:US
Mailing Address - Phone:813-818-0142
Mailing Address - Fax:
Practice Address - Street 1:3850 TAMPA RD
Practice Address - Street 2:BUILDING A, SUITE 200
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3670
Practice Address - Country:US
Practice Address - Phone:727-786-5482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4686235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist