Basic Information
| Provider Information | |||||||||
| NPI: | 1265699730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WASHER | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS CCC SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 W BERGEN CT | ||||||||
| Address2: | |||||||||
| City: | FOX POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532172304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143510722 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6263 NORTH GREENBAY AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143510543 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 12/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 343154 | WI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 42688500 | 05 | WI | MEDICAID |