Healthcare Provider Details

I. General information

NPI: 1336751478
Provider Name (Legal Business Name): SARAH JEAN GORMAN SLP-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 OLD JACKSBORO HWY, ST 101
WICHITA FALLS TX
76302
US

IV. Provider business mailing address

4309 OLD JACKSBORO HWY, ST 101
WICHITA FALLS TX
76302
US

V. Phone/Fax

Practice location:
  • Phone: 940-386-1004
  • Fax: 903-465-5533
Mailing address:
  • Phone: 940-386-1004
  • Fax: 903-465-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number117210
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: