Provider Demographics
NPI:1265625255
Name:SANDORA, JENNIFER LYNNE (MSCCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNNE
Last Name:SANDORA
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:257 GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-9740
Mailing Address - Country:US
Mailing Address - Phone:724-846-8200
Mailing Address - Fax:724-847-2998
Practice Address - Street 1:257 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-9740
Practice Address - Country:US
Practice Address - Phone:724-846-8200
Practice Address - Fax:724-847-2998
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist