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NPI Code Detail

MEDICARE: SANDRA ANN RYAN M.A., CCC-LP

MEDICARE: SANDRA ANN RYAN M.A., CCC-LP
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
1235Z00000XSpeech-Language PathologistSLP1473AZ

General Provider Information

NPI Number : 1609072941
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA ANN RYAN M.A., CCC-LP
Provider Business Mailing Address
First Line : 775 N LONE OAK WAY
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-5814
Country : US
Telephone Number : 928-527-9929
Fax Number :
Provider Business Practice Location Address
First Line : 3150 N WINDING BROOK RD
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86001-0972
Country : US
Telephone Number : 928-774-7106
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2007
Last Update Date : 07/08/2007

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