1710417076 NPI number — SANDRA MILTON MA, CCC-SLP, CCM

Table of content: SANDRA MILTON MA, CCC-SLP, CCM (NPI 1710417076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710417076 NPI number — SANDRA MILTON MA, CCC-SLP, CCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILTON
Provider First Name:
SANDRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, CCC-SLP, CCM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710417076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13636 VENTURA BLVD
Provider Second Line Business Mailing Address:
#420
Provider Business Mailing Address City Name:
SHERMAN OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91423-3700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-763-9997
Provider Business Mailing Address Fax Number:
818-763-9979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13636 VENTURA BLVD
Provider Second Line Business Practice Location Address:
#420
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91423-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-763-9997
Provider Business Practice Location Address Fax Number:
818-763-9979
Provider Enumeration Date:
06/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  4230 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com