Basic Information
Provider Information | |||||||||
NPI: | 1184122244 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BACULI | ||||||||
FirstName: | SARAH | ||||||||
MiddleName: | MCMENAMIN | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MCMENAMIN | ||||||||
OtherFirstName: | SARAH | ||||||||
OtherMiddleName: | ELAINE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 7900 CHURCHILL WAY APT 4301 | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752512024 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9723338252 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 9900 N CENTRAL EXPY | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752314395 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2142650420 | ||||||||
FaxNumber: | 2142650737 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/24/2018 | ||||||||
LastUpdateDate: | 11/01/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/01/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 114293 | TX | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
No ID Information.