Provider Demographics
NPI:1306190046
Name:WASSERMAN, SANDRA A
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:A
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1984 SODA MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9407
Mailing Address - Country:US
Mailing Address - Phone:541-482-1330
Mailing Address - Fax:
Practice Address - Street 1:1984 SODA MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9407
Practice Address - Country:US
Practice Address - Phone:541-482-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist