Provider Demographics
NPI:1376745604
Name:PACHA, SANDRA (SLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PACHA
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 1:1047 OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:IA
Mailing Address - Zip Code:52585-8001
Mailing Address - Country:US
Mailing Address - Phone:319-694-3850
Mailing Address - Fax:
Practice Address - Street 1:102 NORTH JACKSON
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:IA
Practice Address - Zip Code:52654
Practice Address - Country:US
Practice Address - Phone:615-896-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01403235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist