Healthcare Provider Details

I. General information

NPI: 1417538463
Provider Name (Legal Business Name): SARAH STOLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 W BULLARD AVE STE 102
FRESNO CA
93704-1755
US

IV. Provider business mailing address

4514 W OSWEGO AVE
FRESNO CA
93722-2567
US

V. Phone/Fax

Practice location:
  • Phone: 559-205-0930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: