Healthcare Provider Details

I. General information

NPI: 1386032902
Provider Name (Legal Business Name): SARAH BECK M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 E MAIN ST
BROWNSBURG IN
46112-1433
US

IV. Provider business mailing address

1353 E MAIN ST
BROWNSBURG IN
46112-1433
US

V. Phone/Fax

Practice location:
  • Phone: 317-294-5242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14110600
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: