Individual
SARA J. PROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17901 205TH AVE NW, BIG LAKE, MN 55309-4659
(763) 262-8100
Mailing address
17901 205TH AVE NW, BIG LAKE, MN 55309-4659
(763) 262-8100
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
356680
MN
Other
Enumeration date
04/02/2026
Last updated
04/02/2026
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