Healthcare Provider Details

I. General information

NPI: 1700845500
Provider Name (Legal Business Name): TIFFANY CASANDRA SANFORD-MARTENS PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 09/12/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOSPITAL DR
COLUMBIA MO
65201-5275
US

IV. Provider business mailing address

800 HOSPITAL DR
COLUMBIA MO
65201-5275
US

V. Phone/Fax

Practice location:
  • Phone: 573-814-6000
  • Fax:
Mailing address:
  • Phone: 573-814-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number016207-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: