Provider Demographics
NPI:1780957175
Name:BREWER, SARAH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:THOMAS
Mailing Address - State:OK
Mailing Address - Zip Code:73669-8201
Mailing Address - Country:US
Mailing Address - Phone:580-661-2639
Mailing Address - Fax:580-661-2640
Practice Address - Street 1:100 S 2ND ST
Practice Address - Street 2:
Practice Address - City:THOMAS
Practice Address - State:OK
Practice Address - Zip Code:73669-8201
Practice Address - Country:US
Practice Address - Phone:580-661-2639
Practice Address - Fax:580-661-2640
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist