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General NPI Number Information
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NPI Number | 1962693226
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Entity Type | Individual
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Provider Name | SANDRA ELIZABETH CARLSON SLP
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Gender | Female
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 330 WALKER AVE
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City | WAHIAWA
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State | HI
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Zip | 96786-1821
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Country | US
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Telephone | 808-622-6329
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Fax |
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Provider Business Mailing Address
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Address Line | 95-1071 KUALAPA ST
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City | MILILANI
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State | HI
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Zip | 96789-4272
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP248
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License Number State | HI
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