Provider Demographics
NPI:1982185047
Name:GROMKO, SARAH A (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:GROMKO
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 1:189 WOOSTER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5737
Mailing Address - Country:US
Mailing Address - Phone:917-518-7772
Mailing Address - Fax:
Practice Address - Street 1:189 WOOSTER ST APT 1
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5737
Practice Address - Country:US
Practice Address - Phone:917-518-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND235Z00000X
CT6315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist