Basic Information
| Provider Information | |||||||||
| NPI: | 1588979058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GASKELL | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | CCC-SLP SLP.D RPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 576649 | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953576649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095718330 | ||||||||
| FaxNumber: | 2094917184 | ||||||||
| Practice Location | |||||||||
| Address1: | 3117 MCHENRY AVE | ||||||||
| Address2: | B | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953501470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095441032 | ||||||||
| FaxNumber: | 2094917184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2010 | ||||||||
| LastUpdateDate: | 12/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 12114980 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 5718 | CA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 4218926 | AZ | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.