Provider Demographics
NPI:1962510198
Name:RAYNER, SANDRA ELIZABETH (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:RAYNER
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 EXPOSITION BLVD
Mailing Address - Street 2:BLDG 700
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4314
Mailing Address - Country:US
Mailing Address - Phone:916-736-3404
Mailing Address - Fax:916-233-4171
Practice Address - Street 1:1111 EXPOSITION BLVD
Practice Address - Street 2:BLDG 700
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4314
Practice Address - Country:US
Practice Address - Phone:916-736-3404
Practice Address - Fax:916-233-4171
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISR000207231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI40-4683793Medicaid
MISR000207OtherSTATE LICENSE NUMBER
MISR104555OtherASHA NUMBER
MI640C710400OtherBCBS
MI640C710400OtherBCBS