Provider Demographics
NPI:1295822732
Name:GAUB, SANDRA (ST)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:GAUB
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 DALECREST DR UNIT 1112B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-1765
Mailing Address - Country:US
Mailing Address - Phone:775-315-0235
Mailing Address - Fax:
Practice Address - Street 1:6200 W OAKEY BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1103
Practice Address - Country:US
Practice Address - Phone:702-870-7050
Practice Address - Fax:702-870-7616
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-310235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508871Medicaid