Provider Demographics
NPI:1043878101
Name:GREEN, SARAH EMILY (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:EMILY
Last Name:GREEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 STILLWATER TRL
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-6230
Mailing Address - Country:US
Mailing Address - Phone:281-923-5410
Mailing Address - Fax:
Practice Address - Street 1:1621 COIT RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6141
Practice Address - Country:US
Practice Address - Phone:281-923-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist