Provider Demographics
NPI:1043781081
Name:WEST, SABRENIA RENEE (MACCCSLP)
Entity Type:Individual
Prefix:MS
First Name:SABRENIA
Middle Name:RENEE
Last Name:WEST
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30077-0794
Mailing Address - Country:US
Mailing Address - Phone:678-725-4628
Mailing Address - Fax:
Practice Address - Street 1:573 W 37TH PL
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-4527
Practice Address - Country:US
Practice Address - Phone:678-725-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP10325235Z00000X
GAGA04287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist