Provider Demographics
NPI:1508336553
Name:SEASTRAND, ANN JACOBSON (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:JACOBSON
Last Name:SEASTRAND
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 SAINT ANNES DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-5715
Mailing Address - Country:US
Mailing Address - Phone:801-636-6561
Mailing Address - Fax:
Practice Address - Street 1:11091 KILKERRAN CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-4356
Practice Address - Country:US
Practice Address - Phone:702-816-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14313245235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist