Provider Demographics
NPI:1053092718
Name:GARDNER, SARA ELIZABETH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 GROVE ST STE 2400
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2273
Mailing Address - Country:US
Mailing Address - Phone:617-969-8255
Mailing Address - Fax:
Practice Address - Street 1:242 COREY RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-8324
Practice Address - Country:US
Practice Address - Phone:203-241-1926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist