MEDICARE: SARAH LAURIE FEDOR SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	022129	NY
2	235Z00000X	Speech-Language Pathologist	109032	TX

General Provider Information

NPI Number	:	1174871321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LAURIE FEDOR SLP

Provider Business Mailing Address
First Line	:	6005 WESTVIEW DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055
Country	:	US
Telephone Number	:	713-696-2130
Fax Number	:	713-696-2133

Provider Business Practice Location Address
First Line	:	6005 WESTVIEW DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055
Country	:	US
Telephone Number	:	713-696-2130
Fax Number	:	713-696-2133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2012
Last Update Date	:	07/14/2014

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Directions to “ SARAH LAURIE FEDOR SLP” Practice Location

Language	Start Address	Practice Location

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