Provider Demographics
NPI:1639650567
Name:NICHOLAS, SARAH (CFY-SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 TROPIC ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1953
Mailing Address - Country:US
Mailing Address - Phone:330-571-6139
Mailing Address - Fax:
Practice Address - Street 1:16349 BEAVER PIKE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-8511
Practice Address - Country:US
Practice Address - Phone:740-286-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.2018680-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist