Provider Demographics
NPI:1356522981
Name:LASERSON, SANDRA S (MA CCC-SLP SP-3778)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:S
Last Name:LASERSON
Suffix:
Gender:F
Credentials:MA CCC-SLP SP-3778
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 SULGRAVE ROAD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-849-1551
Mailing Address - Fax:
Practice Address - Street 1:2721 SULGRAVE ROAD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-849-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.3778235Z00000X
OHSP-3778235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist