Provider Demographics
NPI:1952598989
Name:LASAROW, SANDY SHANIN (MA, CCC)
Entity Type:Individual
Prefix:MS
First Name:SANDY
Middle Name:SHANIN
Last Name:LASAROW
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:SHANIN
Other - Last Name:LASAROW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC
Mailing Address - Street 1:231 CEDAR HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1756
Mailing Address - Country:US
Mailing Address - Phone:805-492-8899
Mailing Address - Fax:805-492-6839
Practice Address - Street 1:231 CEDAR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1756
Practice Address - Country:US
Practice Address - Phone:805-492-8899
Practice Address - Fax:805-492-6839
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist