Provider Demographics
NPI:1366872806
Name:PALENCIA, SARA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:PALENCIA
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 1:3359 MENTONE AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4673
Mailing Address - Country:US
Mailing Address - Phone:310-433-4365
Mailing Address - Fax:
Practice Address - Street 1:3359 MENTONE AVE
Practice Address - Street 2:APT 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-4673
Practice Address - Country:US
Practice Address - Phone:310-433-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP24161235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist