Healthcare Provider Details

I. General information

NPI: 1265566228
Provider Name (Legal Business Name): SARAH EVELYN HODSON MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 GLEN ELLEN DR
BLOOMINGTON IN
47404-9527
US

IV. Provider business mailing address

2720 GLEN ELLEN DR
BLOOMINGTON IN
47404-9527
US

V. Phone/Fax

Practice location:
  • Phone: 812-320-8692
  • Fax: 812-876-5419
Mailing address:
  • Phone: 812-320-8692
  • Fax: 812-876-5419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22004309A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: