Healthcare Provider Details

I. General information

NPI: 1528041019
Provider Name (Legal Business Name): SARA KEMP SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 C WOODLAND SQUARE LP. SE
LACEY WA
98513
US

IV. Provider business mailing address

669C WOODLAND SQUARE LP. SE
LACEY WA
98513
US

V. Phone/Fax

Practice location:
  • Phone: 360-357-3339
  • Fax: 360-786-1793
Mailing address:
  • Phone: 360-357-3339
  • Fax: 360-786-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00002472
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: