Provider Demographics
NPI:1184122244
Name:BACULI, SARAH MCMENAMIN
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:MCMENAMIN
Last Name:BACULI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:ELAINE
Other - Last Name:MCMENAMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7900 CHURCHILL WAY APT 4301
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2024
Mailing Address - Country:US
Mailing Address - Phone:972-333-8252
Mailing Address - Fax:
Practice Address - Street 1:9900 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4395
Practice Address - Country:US
Practice Address - Phone:214-265-0420
Practice Address - Fax:214-265-0737
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist