Provider Demographics
NPI:1306096839
Name:NIELSEN, SARA DEEANNE (MA, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:DEEANNE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2739
Mailing Address - Country:US
Mailing Address - Phone:509-838-6060
Mailing Address - Fax:509-838-6464
Practice Address - Street 1:707 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2739
Practice Address - Country:US
Practice Address - Phone:509-838-6060
Practice Address - Fax:509-838-6464
Is Sole Proprietor?:No
Enumeration Date:2008-09-20
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist