Provider Demographics
NPI:1851535082
Name:NELSON, SARA JO
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JO
Last Name:NELSON
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 1:7819 HEMPHILL DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3523
Mailing Address - Country:US
Mailing Address - Phone:858-349-7820
Mailing Address - Fax:858-547-9051
Practice Address - Street 1:7819 HEMPHILL DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-3523
Practice Address - Country:US
Practice Address - Phone:858-349-7820
Practice Address - Fax:858-547-9051
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist