Provider Demographics
NPI:1619277373
Name:VAN DAME, SARAH KIRSTEN (MA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KIRSTEN
Last Name:VAN DAME
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 OXEN ST
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-4655
Mailing Address - Country:US
Mailing Address - Phone:805-305-0906
Mailing Address - Fax:805-880-5859
Practice Address - Street 1:784 OXEN ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-4655
Practice Address - Country:US
Practice Address - Phone:805-305-0906
Practice Address - Fax:805-880-5859
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist