Provider Demographics
NPI:1093836355
Name:SACKS, TERRY ANN (MA CCC LSP)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:ANN
Last Name:SACKS
Suffix:
Gender:F
Credentials:MA CCC LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-9078
Mailing Address - Country:US
Mailing Address - Phone:360-650-3196
Mailing Address - Fax:360-650-2843
Practice Address - Street 1:516 HIGH ST.
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-9078
Practice Address - Country:US
Practice Address - Phone:360-650-3196
Practice Address - Fax:360-650-2843
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0916000562-22OtherDVR GROUP #
WA7140007Medicaid