Provider Demographics
NPI:1669096178
Name:LETSKY, SARAH SMITH (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:SMITH
Last Name:LETSKY
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13214 SORRENTO WAY
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-2175
Mailing Address - Country:US
Mailing Address - Phone:978-886-1174
Mailing Address - Fax:
Practice Address - Street 1:13214 SORRENTO WAY
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-2175
Practice Address - Country:US
Practice Address - Phone:978-886-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty