MEDICARE: MS. SANDY HIRSCH MS CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	LL00002931	WA

General Provider Information

NPI Number	:	1922169820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDY HIRSCH MS CCC/SLP

Provider Business Mailing Address
First Line	:	819 31ST AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-5023
Country	:	US
Telephone Number	:	206-718-4387
Fax Number	:

Provider Business Practice Location Address
First Line	:	819 31ST AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-5023
Country	:	US
Telephone Number	:	206-718-4387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	04/23/2014

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