Provider Demographics
NPI:1366606436
Name:SANDERSON, JAIME M
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:M
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 PARKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1153
Mailing Address - Country:US
Mailing Address - Phone:317-826-1853
Mailing Address - Fax:317-826-1938
Practice Address - Street 1:136 PARKVIEW RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1153
Practice Address - Country:US
Practice Address - Phone:317-826-1853
Practice Address - Fax:317-826-1938
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004631A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22004631AOtherLICENSE