Provider Demographics
NPI:1174229884
Name:CHILDERS, SARAH KATHERINE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHERINE
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MATUK DR
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2827
Mailing Address - Country:US
Mailing Address - Phone:662-871-1354
Mailing Address - Fax:
Practice Address - Street 1:15 SULLIVAN AVE STE 1W
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-2218
Practice Address - Country:US
Practice Address - Phone:845-295-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP118230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist