Provider Demographics
NPI:1548335953
Name:SANDERS, KATHRYN LYNNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYNNE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-0462
Mailing Address - Country:US
Mailing Address - Phone:219-865-9354
Mailing Address - Fax:
Practice Address - Street 1:1743 SELO DR
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2250
Practice Address - Country:US
Practice Address - Phone:219-865-9354
Practice Address - Fax:219-865-9374
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002260A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist