Provider Demographics
NPI:1609616382
Name:SARA RIDGWAY BURKLOW SPEECH THERAPY LLC
Entity type:Organization
Organization Name:SARA RIDGWAY BURKLOW SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:EMILY
Authorized Official - Last Name:RIDGWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:609-312-6520
Mailing Address - Street 1:115 ROUTE 46 STE B11
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1656
Mailing Address - Country:US
Mailing Address - Phone:609-920-2351
Mailing Address - Fax:
Practice Address - Street 1:115 ROUTE 46 STE B11
Practice Address - Street 2:
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1656
Practice Address - Country:US
Practice Address - Phone:609-920-2351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty