MEDICARE: SARAH C COONS MS 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	12834	NY

General Provider Information

NPI Number	:	1669626578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH C COONS MS CCC-SLP

Provider Business Mailing Address
First Line	:	419 VISCHER FERRY RD
Second Line	:
City	:	CLIFTON PARK
State	:	NY
Zip	:	12065
Country	:	US
Telephone Number	:	518-371-7064
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 VISCHER FERRY ROAD
Second Line	:
City	:	CLIFTON PARK
State	:	NY
Zip	:	12065-1609
Country	:	US
Telephone Number	:	518-371-7064
Fax Number	:

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

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	11/06/2008

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Directions to “ SARAH C COONS MS CCC-SLP” Practice Location

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