MEDICARE: SARA KATE WEISS CCC-SLP

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	09027	MD

General Provider Information

NPI Number	:	1134701816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA KATE WEISS CCC-SLP

Provider Business Mailing Address
First Line	:	4 SUNNYDALE WAY
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-6119
Country	:	US
Telephone Number	:	443-933-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	8508 LOCH RAVEN BLVD
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-2354
Country	:	US
Telephone Number	:	443-469-3426
Fax Number	:

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

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	04/22/2021

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Directions to “ SARA KATE WEISS CCC-SLP” Practice Location

Language	Start Address	Practice Location

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