Provider Demographics
NPI:1235286774
Name:SMITS, SARAH CONNOLLY
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:CONNOLLY
Last Name:SMITS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:LOUISE
Other - Last Name:CONNOLLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MST CCCSLP
Mailing Address - Street 1:410 S 3RD ST
Mailing Address - Street 2:B30 WYMAN EDUCATION BLDG SPEECH & HRG CLINIC
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022
Mailing Address - Country:US
Mailing Address - Phone:715-425-3801
Mailing Address - Fax:715-425-3800
Practice Address - Street 1:410 S 3RD ST
Practice Address - Street 2:B30 WYMAN EDUCATION BLDG SPEECH & HRG CLINIC
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022
Practice Address - Country:US
Practice Address - Phone:715-425-3801
Practice Address - Fax:715-425-3800
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1739154235Z00000X
MN7046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN286K95MOtherBCBS