Provider Demographics
NPI:1386850782
Name:KORTHAS, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:KORTHAS
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 1:2609 FARINGDON CT
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1343
Mailing Address - Country:US
Mailing Address - Phone:262-547-5973
Mailing Address - Fax:
Practice Address - Street 1:CENTER FOR BLIND & VISUALLY IMPAIRED CHILDREN
Practice Address - Street 2:5600 W BROWN DEER RD, STE. 4
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223
Practice Address - Country:US
Practice Address - Phone:414-355-3060
Practice Address - Fax:414-355-3547
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42692900Medicaid