Healthcare Provider Details

I. General information

NPI: 1578716957
Provider Name (Legal Business Name): SARA KITCHEN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 BAY LAUREL DR
MOORESVILLE NC
28115-7187
US

IV. Provider business mailing address

3696 NORTH ST PO BOX 22
MADISON NY
13402
US

V. Phone/Fax

Practice location:
  • Phone: 704-301-2683
  • Fax:
Mailing address:
  • Phone: 704-431-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number015523-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9059
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: