Provider Demographics
NPI:1730352469
Name:CHESNUT, SARAH (LHS)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:CHESNUT
Suffix:
Gender:F
Credentials:LHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140-1846
Mailing Address - Country:US
Mailing Address - Phone:903-962-5526
Mailing Address - Fax:903-962-6185
Practice Address - Street 1:208 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-1846
Practice Address - Country:US
Practice Address - Phone:903-962-5526
Practice Address - Fax:903-962-6185
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50683237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2128803Medicaid