Provider Demographics
NPI:1770776395
Name:MATTSON, SARA LOUISE (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LOUISE
Last Name:MATTSON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LOUISE
Other - Last Name:MADISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD,CCC-A
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-0524
Mailing Address - Country:US
Mailing Address - Phone:858-759-8922
Mailing Address - Fax:858-759-8022
Practice Address - Street 1:6037 LA GRANADA
Practice Address - Street 2:SUITE D
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92067
Practice Address - Country:US
Practice Address - Phone:858-759-8922
Practice Address - Fax:858-759-8022
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2370231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist