Active NPI
Cheryl Sack
- Speech-Language Pathologist
- Burien, WA
National Provider Identifier
1639414568
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- LL 00001768
- Practice address
- 15675 Ambaum Blvd SW
Burien, WA 98166-2523 - Phone
- (206) 433-2125
- NPI assigned
- Dec 4, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | LL 00001768 | WA | Primary |
Addresses
Primary practice location
15675 Ambaum Blvd SW
Burien, WA 98166-2523
Mailing address
1962 SW 172ND St
Burien, WA 98166-3351
Phone (206) 246-7377
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LL 00001768 | Other | WA | SPEECH LANGUAGE PATHOLOGIST LICENSE WASHINGTON STATE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LL 00001768 | WA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354579200000",
"number": "1639414568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1962 SW 172ND ST",
"city": "BURIEN",
"state": "WA",
"postal_code": "981663351",
"telephone_number": "206-246-7377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15675 AMBAUM BLVD SW",
"city": "BURIEN",
"state": "WA",
"postal_code": "981662523",
"telephone_number": "206-433-2125"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SACK",
"first_name": "CHERYL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-12-04",
"last_updated": "2012-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WA",
"license": "LL 00001768",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPEECH LANGUAGE PATHOLOGIST LICENSE WASHINGTON STATE",
"identifier": "LL 00001768",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burien, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.