Healthcare Provider Details

I. General information

NPI: 1518376540
Provider Name (Legal Business Name): SARAH LYN MARSHALL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 N WARSON RD
SAINT LOUIS MO
63132-1810
US

IV. Provider business mailing address

1177 N WARSON RD
SAINT LOUIS MO
63132-1810
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-2211
  • Fax: 314-569-0778
Mailing address:
  • Phone: 314-569-2211
  • Fax: 314-569-0778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2014024671
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2015023525
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: