Provider Demographics
NPI:1649951526
Name:ANDERSON, SABRA (MA, SLP)
Entity type:Individual
Prefix:
First Name:SABRA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 GREEN ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3218
Mailing Address - Country:US
Mailing Address - Phone:908-377-6109
Mailing Address - Fax:
Practice Address - Street 1:822 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1937
Practice Address - Country:US
Practice Address - Phone:215-220-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSL002143235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist