Provider Demographics
NPI:1013462936
Name:GUNDERSON, SARAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12228 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-4405
Mailing Address - Country:US
Mailing Address - Phone:206-706-0090
Mailing Address - Fax:
Practice Address - Street 1:12228 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98177-4405
Practice Address - Country:US
Practice Address - Phone:206-706-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60233984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist