Provider Demographics
NPI:1689140956
Name:JEFFERSON, SINDHU (SLPA)
Entity Type:Individual
Prefix:
First Name:SINDHU
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5071 ROWAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5879
Mailing Address - Country:US
Mailing Address - Phone:408-489-4379
Mailing Address - Fax:
Practice Address - Street 1:ASCEND REHAB SERVICES
Practice Address - Street 2:29516 KOHOUTEK WAY
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587
Practice Address - Country:US
Practice Address - Phone:510-362-0827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9272355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA927OtherCALIFORNIA SPEECH AND AUDIOLOGY BOARD