Provider Demographics
NPI:1205431079
Name:BOOKOUT, SARAH ALENE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ALENE
Last Name:BOOKOUT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FIR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4626
Mailing Address - Country:US
Mailing Address - Phone:915-667-8591
Mailing Address - Fax:
Practice Address - Street 1:110 FIR DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4626
Practice Address - Country:US
Practice Address - Phone:915-667-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119899235Z00000X
COPSLP.0000702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPSLP.0000702OtherDORA