Provider Demographics
NPI:1114073855
Name:HAMBACHER, SANDRA (SLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HAMBACHER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 E CERRADA EL OCOTE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3171
Mailing Address - Country:US
Mailing Address - Phone:520-615-7656
Mailing Address - Fax:
Practice Address - Street 1:11279 W GRIER RD
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-9609
Practice Address - Country:US
Practice Address - Phone:520-616-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP2083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist