MEDICARE: SARAH ELIZABETH WILLIAMS M.A. 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	8192	MN

General Provider Information

NPI Number	:	1790943611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELIZABETH WILLIAMS M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	6776 LAKE DR
Second Line	:	SUITE 220
City	:	LINO LAKES
State	:	MN
Zip	:	55014-1191
Country	:	US
Telephone Number	:	651-784-7007
Fax Number	:

Provider Business Practice Location Address
First Line	:	6776 LAKE DR
Second Line	:	SUITE 220
City	:	LINO LAKES
State	:	MN
Zip	:	55014-1191
Country	:	US
Telephone Number	:	651-784-7007
Fax Number	:

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

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	06/07/2016

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