MEDICARE: SARA ROBERTSON M.S., CCC-SLP, ATP

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

General Provider Information

NPI Number	:	1275967630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA ROBERTSON M.S., CCC-SLP, ATP

Provider Business Mailing Address
First Line	:	34 CARROLLS PIT RD
Second Line	:
City	:	WEST NEWFIELD
State	:	ME
Zip	:	04095-3167
Country	:	US
Telephone Number	:	617-501-1777
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 CARROLLS PIT RD
Second Line	:
City	:	WEST NEWFIELD
State	:	ME
Zip	:	04095-3167
Country	:	US
Telephone Number	:	617-501-1777
Fax Number	:

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

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/27/2024

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