Provider Demographics
NPI:1669898003
Name:DADVAND, SARA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:DADVAND
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 1:11540 SANTA MONICA BLVD
Mailing Address - Street 2:#203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7905
Mailing Address - Country:US
Mailing Address - Phone:310-403-2765
Mailing Address - Fax:310-914-7600
Practice Address - Street 1:11540 SANTA MONICA BLVD
Practice Address - Street 2:#203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7905
Practice Address - Country:US
Practice Address - Phone:310-403-2765
Practice Address - Fax:310-914-7633
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17395235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist