Provider Demographics
NPI:1275696544
Name:WENDSCHLAG, SANDRA JEAN (AUD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:WENDSCHLAG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 W FREMONT AVE
Mailing Address - Street 2:SUITE I--4
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2315
Mailing Address - Country:US
Mailing Address - Phone:408-773-9933
Mailing Address - Fax:408-773-0325
Practice Address - Street 1:877 W FREMONT AVE
Practice Address - Street 2:SUITE I--4
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2315
Practice Address - Country:US
Practice Address - Phone:408-773-9933
Practice Address - Fax:408-773-0325
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1103231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0011030Medicaid
CAAU1103Medicare UPIN
CAAU0011030Medicaid