Healthcare Provider Details

I. General information

NPI: 1548164627
Provider Name (Legal Business Name): MRS. SARA LYNN MCLEOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W M35
GWINN MI
49841-9180
US

IV. Provider business mailing address

1301 RYAN AVE APT 10
MARQUETTE MI
49855-1281
US

V. Phone/Fax

Practice location:
  • Phone: 231-878-4370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009127
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: