Provider Demographics
NPI:1558400465
Name:HERRON, SARAH A (LL)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:HERRON
Suffix:
Gender:F
Credentials:LL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 S PINE ST STE 219
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7205
Mailing Address - Country:US
Mailing Address - Phone:253-476-6550
Mailing Address - Fax:253-476-6551
Practice Address - Street 1:4301 S PINE ST STE 219
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7205
Practice Address - Country:US
Practice Address - Phone:253-476-6550
Practice Address - Fax:253-476-6551
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002802235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8399628Medicaid