Provider Demographics
NPI:1053485169
Name:SPENCER, SARA HOLLISTER (MS CCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:HOLLISTER
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WOODACRE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1658
Mailing Address - Country:US
Mailing Address - Phone:415-661-2709
Mailing Address - Fax:415-664-8850
Practice Address - Street 1:90 WOODACRE DR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1658
Practice Address - Country:US
Practice Address - Phone:415-661-2709
Practice Address - Fax:415-664-8850
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-2849925OtherTIN