Provider Demographics
NPI:1538414099
Name:SWIST, SARAH (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:SWIST
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:5090 INDIAN NECK LANE
Mailing Address - City:PECONIC
Mailing Address - State:NY
Mailing Address - Zip Code:11958-0345
Mailing Address - Country:US
Mailing Address - Phone:631-793-9963
Mailing Address - Fax:
Practice Address - Street 1:5090 INDIAN NECK LN
Practice Address - Street 2:
Practice Address - City:PECONIC
Practice Address - State:NY
Practice Address - Zip Code:11958-1712
Practice Address - Country:US
Practice Address - Phone:631-793-9963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist