Healthcare Provider Details

I. General information

NPI: 1295130904
Provider Name (Legal Business Name): SARA HANES M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4147 DUNSMORE AVE
LA CRESCENTA CA
91214
US

IV. Provider business mailing address

24325 ASTOR RACING CT
VALENCIA CA
91354-4918
US

V. Phone/Fax

Practice location:
  • Phone: 818-248-1758
  • Fax:
Mailing address:
  • Phone: 310-439-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1295130904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: