Provider Demographics
NPI:1013998855
Name:OSBORN, SANDRA KAY (LL)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:KAY
Last Name:OSBORN
Suffix:
Gender:F
Credentials:LL
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:KAY
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3920 NW FAIRWAY LN
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1341
Mailing Address - Country:US
Mailing Address - Phone:360-377-9945
Mailing Address - Fax:
Practice Address - Street 1:1141 BEACH DR E
Practice Address - Street 2:
Practice Address - City:RETSIL
Practice Address - State:WA
Practice Address - Zip Code:98378
Practice Address - Country:US
Practice Address - Phone:360-895-4700
Practice Address - Fax:360-895-4453
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003016235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist