Provider Demographics
NPI:1518081256
Name:PEARSON KING, SANDRA (MS CD SLP CCC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:PEARSON KING
Suffix:
Gender:F
Credentials:MS CD SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:SUITE 001
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-0194
Mailing Address - Country:US
Mailing Address - Phone:603-569-6755
Mailing Address - Fax:603-941-0677
Practice Address - Street 1:6 LARY ROAD
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-0194
Practice Address - Country:US
Practice Address - Phone:603-569-6755
Practice Address - Fax:603-941-0677
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0327235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30004154Medicaid
NH11364307OtherCAQH
NH660357440NH04OtherANTHEN BLUE CROSS