Provider Demographics
NPI:1376897272
Name:SIMON, SANDRA LEA (MSPA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEA
Last Name:SIMON
Suffix:
Gender:F
Credentials:MSPA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SAMISH LN
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-9321
Mailing Address - Country:US
Mailing Address - Phone:360-676-0165
Mailing Address - Fax:
Practice Address - Street 1:5200 TURKINGTON RD
Practice Address - Street 2:
Practice Address - City:ACME
Practice Address - State:WA
Practice Address - Zip Code:98220
Practice Address - Country:US
Practice Address - Phone:360-383-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60312910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist