Provider Demographics
NPI:1265729305
Name:WASSERMAN, SARA (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WASSERMAN
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 1:350 N MAIN ST
Mailing Address - Street 2:#508
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-4122
Mailing Address - Country:US
Mailing Address - Phone:248-737-3430
Mailing Address - Fax:248-737-3433
Practice Address - Street 1:6625 DALY RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3410
Practice Address - Country:US
Practice Address - Phone:248-737-3430
Practice Address - Fax:248-737-3433
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist