Provider Demographics
NPI:1386295103
Name:SANVICTORES, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SANVICTORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10251 RIDGELINE DR APT R360
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-5157
Mailing Address - Country:US
Mailing Address - Phone:509-205-3072
Mailing Address - Fax:
Practice Address - Street 1:7203 W DESCHUTES AVE STE A
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7777
Practice Address - Country:US
Practice Address - Phone:509-619-7397
Practice Address - Fax:866-798-0203
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WALL61564577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician