Provider Demographics
NPI:1053801514
Name:FARISON, SARAH KRISTINE (MS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KRISTINE
Last Name:FARISON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KRISTINE
Other - Last Name:MICKSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:3222 W FULLER DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-6004
Mailing Address - Country:US
Mailing Address - Phone:847-596-0445
Mailing Address - Fax:
Practice Address - Street 1:3222 W FULLER DR
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-6004
Practice Address - Country:US
Practice Address - Phone:847-596-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP11609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist