Provider Demographics
NPI:1902475106
Name:CHAVARRIA, SANDRA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CHAVARRIA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN LORENZO UNIFIED SCHOOL DISTRICT, SPECIAL SVCS DEPT
Mailing Address - Street 2:15510 USHER STREET
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580
Mailing Address - Country:US
Mailing Address - Phone:510-852-9105
Mailing Address - Fax:
Practice Address - Street 1:15510 USHER ST
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-1641
Practice Address - Country:US
Practice Address - Phone:510-852-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20286235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist