Healthcare Provider Details

I. General information

NPI: 1275018855
Provider Name (Legal Business Name): LAUREN SASAKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 HOWE AVE STE 207
SACRAMENTO CA
95825-3364
US

IV. Provider business mailing address

1010 STAFFORD ST
LODI CA
95242-3850
US

V. Phone/Fax

Practice location:
  • Phone: 707-344-1771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: