Healthcare Provider Details

I. General information

NPI: 1477941268
Provider Name (Legal Business Name): JAMES DONITH SANDERS X M.S., CCC/SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PHILLIPS BRANCH RD
PHELPS KY
41553-9061
US

IV. Provider business mailing address

171 NIGHTINGALE LN
PIKEVILLE KY
41501-7027
US

V. Phone/Fax

Practice location:
  • Phone: 606-456-8725
  • Fax:
Mailing address:
  • Phone: 606-205-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberKY2475
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: