Provider Demographics
NPI:1043758071
Name:SUGIARTO, AMERIND (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMERIND
Middle Name:
Last Name:SUGIARTO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7466 ASTER CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4801
Mailing Address - Country:US
Mailing Address - Phone:925-209-4880
Mailing Address - Fax:
Practice Address - Street 1:7466 ASTER CT
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4801
Practice Address - Country:US
Practice Address - Phone:925-209-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist