Provider Demographics
NPI:1598855843
Name:MATTAR, SANDRA (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MATTAR
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 785
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4803
Mailing Address - Country:US
Mailing Address - Phone:310-264-8300
Mailing Address - Fax:310-264-8360
Practice Address - Street 1:2811 WILSHIRE BLVD
Practice Address - Street 2:SUITE 785
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4803
Practice Address - Country:US
Practice Address - Phone:310-264-8300
Practice Address - Fax:310-264-8360
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13917235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist