Provider Demographics
NPI:1619031747
Name:THAU, SANDRA COHN
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:COHN
Last Name:THAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BEETHOVEN AVE
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1749
Mailing Address - Country:US
Mailing Address - Phone:617-824-8315
Mailing Address - Fax:617-824-8733
Practice Address - Street 1:120 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4611
Practice Address - Country:US
Practice Address - Phone:617-824-8315
Practice Address - Fax:617-824-8733
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1424SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist