Provider Demographics
NPI:1023227485
Name:SARASON, LINDA AUDREY (MACCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:AUDREY
Last Name:SARASON
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 BENJAMIN CIR
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9653
Mailing Address - Country:US
Mailing Address - Phone:732-974-1113
Mailing Address - Fax:732-974-6814
Practice Address - Street 1:1330 LAUREL AVE
Practice Address - Street 2:SUITE 304 BUILDING 3
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-2300
Practice Address - Country:US
Practice Address - Phone:732-974-1113
Practice Address - Fax:732-974-6814
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYS00392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist