Provider Demographics
NPI:1760022115
Name:SAGE COMMUNICATION CLINIC
Entity Type:Organization
Organization Name:SAGE COMMUNICATION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAGE
Authorized Official - Middle Name:AIMEE
Authorized Official - Last Name:MERVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:818-645-2682
Mailing Address - Street 1:1114 12TH ST APT 301
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5419
Mailing Address - Country:US
Mailing Address - Phone:818-645-2682
Mailing Address - Fax:
Practice Address - Street 1:528 ARIZONA AVE STE 317
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1440
Practice Address - Country:US
Practice Address - Phone:424-330-0130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech