MEDICARE: MRS. ALEXANDRA ANN SANDERLIN 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	SLP1915	AZ

General Provider Information

NPI Number	:	1396954244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXANDRA ANN SANDERLIN MS CCC SLP

Provider Business Mailing Address
First Line	:	201 WEST MAHONEY ST
Second Line	:
City	:	WINSLOW
State	:	AZ
Zip	:	86047
Country	:	US
Telephone Number	:	928-289-4812
Fax Number	:

Provider Business Practice Location Address
First Line	:	8176 WESTOVER AVE
Second Line	:	JOSEPH CITY PUBLIC SCHOOLS
City	:	JOSEPH CITY
State	:	AZ
Zip	:	86032
Country	:	US
Telephone Number	:	928-288-3329
Fax Number	:	928-288-3317

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. ALEXANDRA ANN SANDERLIN MS CCC SLP” Practice Location

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