MEDICARE: MS. SALLY K SANDLIN ST

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	2355S0801X	Speech-Language Assistant	34590	TX

General Provider Information

NPI Number	:	1467601682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SALLY K SANDLIN ST

Provider Business Mailing Address
First Line	:	1701 S WASHINGTON ST STE C
Second Line	:
City	:	KAUFMAN
State	:	TX
Zip	:	75142-3439
Country	:	US
Telephone Number	:	469-595-3737
Fax Number	:	972-932-5970

Provider Business Practice Location Address
First Line	:	1701 S WASHINGTON ST STE C
Second Line	:
City	:	KAUFMAN
State	:	TX
Zip	:	75142-3439
Country	:	US
Telephone Number	:	469-595-3737
Fax Number	:	972-932-5970

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

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	09/11/2008

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