Provider Demographics
NPI:1669873493
Name:MCCANN, SARAH (MED)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MCCANN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:LAVALLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:2812 W HARE DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2583
Mailing Address - Country:US
Mailing Address - Phone:814-602-8677
Mailing Address - Fax:
Practice Address - Street 1:6103 GERANIUM
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5658
Practice Address - Country:US
Practice Address - Phone:207-462-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3602235Z00000X, 314000000X
FLSA12039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility