MEDICARE: SARAH NICHOLAS CFY-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	COND.2018680-SP	OH

General Provider Information

NPI Number	:	1639650567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH NICHOLAS CFY-SLP

Provider Business Mailing Address
First Line	:	74 TROPIC ST
Second Line	:
City	:	JACKSON
State	:	OH
Zip	:	45640-1953
Country	:	US
Telephone Number	:	330-571-6139
Fax Number	:

Provider Business Practice Location Address
First Line	:	16349 BEAVER PIKE
Second Line	:
City	:	JACKSON
State	:	OH
Zip	:	45640-8511
Country	:	US
Telephone Number	:	740-286-2790
Fax Number	:

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

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	08/28/2018

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Directions to “ SARAH NICHOLAS CFY-SLP” Practice Location

Language	Start Address	Practice Location

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