Basic Information
| Provider Information | |||||||||
| NPI: | 1558400465 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRON | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | L.L. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4301 S PINE ST STE 219 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984097205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534766550 | ||||||||
| FaxNumber: | 2534766551 | ||||||||
| Practice Location | |||||||||
| Address1: | 4301 S PINE ST STE 219 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984097205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534766550 | ||||||||
| FaxNumber: | 2534766551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | LL00002802 | WA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 8399628 | 05 | WA | MEDICAID |