Provider Demographics
NPI:1043650096
Name:PENCE, SARA ELIZABETH (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ELIZABETH
Last Name:PENCE
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 1:688 WOLF RIVER ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-5972
Mailing Address - Country:US
Mailing Address - Phone:606-688-1879
Mailing Address - Fax:
Practice Address - Street 1:275 E MAIN STREET HS2W C
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40621-0001
Practice Address - Country:US
Practice Address - Phone:502-564-3756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-04
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist