Provider Demographics
NPI:1649502261
Name:AMBROSE, SARA C (MA-CCC/SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:C
Last Name:AMBROSE
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 1:304 NEWTON AVE
Mailing Address - Street 2:SUITE 240B
Mailing Address - City:OAKLYN
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:304 NEWTON AVE
Practice Address - Street 2:SUITE 240B
Practice Address - City:OAKLYN
Practice Address - State:NJ
Practice Address - Zip Code:08107-1446
Practice Address - Country:US
Practice Address - Phone:609-254-8106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-07
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00471100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist