Basic Information
| Provider Information | |||||||||
| NPI: | 1326413139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENT | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LONG | ||||||||
| OtherFirstName: | SARAH LONG | ||||||||
| OtherMiddleName: | M. | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.S. CF-SLP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3498 GREEN VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | RESCUE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956729625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303918670 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3498 GREEN VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | RESCUE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956729625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303918670 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2015 | ||||||||
| LastUpdateDate: | 12/04/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 10235 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.