=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649843624
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARAH LOCKHART SPEECH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2021
-----------------------------------------------------
Last Update Date | 07/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 542 WASHINGTON ST STE 102
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97520-1796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-708-3940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1467 SISKIYOU BLVD STE 266
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97520-2336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-708-3940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/SLP
-----------------------------------------------------
Name | MS. SARAH JEAN LOCKHART
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 541-708-3940
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------