MEDICARE: SARAH GREENLEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP-2200	WV

General Provider Information

NPI Number	:	1083365399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH GREENLEE

Provider Business Mailing Address
First Line	:	415 36TH ST STE 100
Second Line	:
City	:	PARKERSBURG
State	:	WV
Zip	:	26101-1005
Country	:	US
Telephone Number	:	304-917-3660
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 GARFIELD AVE STE 2
Second Line	:
City	:	PARKERSBURG
State	:	WV
Zip	:	26101-2529
Country	:	US
Telephone Number	:	304-917-3651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	01/18/2022

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Directions to “ SARAH GREENLEE ” Practice Location

Language	Start Address	Practice Location

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