Provider Demographics
NPI:1962413096
Name:ELLIS, SANDRA KASE (AUD, FAAA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KASE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E JEFFERSON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5698
Mailing Address - Country:US
Mailing Address - Phone:206-320-5687
Mailing Address - Fax:206-320-8145
Practice Address - Street 1:1600 E JEFFERSON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5698
Practice Address - Country:US
Practice Address - Phone:206-320-5687
Practice Address - Fax:206-320-8145
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001067231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7082555Medicaid
R80259Medicare UPIN
WAG217140302Medicare ID - Type Unspecified