Healthcare Provider Details

I. General information

NPI: 1639684897
Provider Name (Legal Business Name): SARA KRIEGER WARE M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 MAIN STREET
EXMORE VA
23350
US

IV. Provider business mailing address

3186 MAIN STREET
EXMORE VA
23350
US

V. Phone/Fax

Practice location:
  • Phone: 757-442-5437
  • Fax:
Mailing address:
  • Phone: 757-442-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202008503
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: