Provider Demographics
NPI:1316294606
Name:MARTIN, SARA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2264 SEGUNDO CT APT 1
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8111
Mailing Address - Country:US
Mailing Address - Phone:925-931-0436
Mailing Address - Fax:
Practice Address - Street 1:125 RYAN INDUSTRIAL CT
Practice Address - Street 2:#205
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1772
Practice Address - Country:US
Practice Address - Phone:925-855-9810
Practice Address - Fax:925-263-1906
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8985235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist