Healthcare Provider Details

I. General information

NPI: 1790206241
Provider Name (Legal Business Name): NICHOLAS JAMES SANFORD M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 01/31/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 129TH ST S
TACOMA WA
98444-5044
US

IV. Provider business mailing address

5601 N 37TH ST APT UU-01
TACOMA WA
98407-9697
US

V. Phone/Fax

Practice location:
  • Phone: 253-298-3000
  • Fax:
Mailing address:
  • Phone: 503-720-6637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL60877190
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: