Provider Demographics
NPI:1720114176
Name:WILCOX, SARA S
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:S
Last Name:WILCOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 CAMPUS
Mailing Address - Street 2:KIDS KAMPUS
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750
Mailing Address - Country:US
Mailing Address - Phone:260-356-0123
Mailing Address - Fax:
Practice Address - Street 1:435 CAMPUS
Practice Address - Street 2:KIDS KAMPUS
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750
Practice Address - Country:US
Practice Address - Phone:260-356-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist