Provider Demographics
NPI:1003061565
Name:SANFORD, CARLENE ANN
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:ANN
Last Name:SANFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLENE
Other - Middle Name:ANN
Other - Last Name:COLEBANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 SOUTH MAIN SUITE 500
Mailing Address - Street 2:HEALING HANDS THERAPY
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143
Mailing Address - Country:US
Mailing Address - Phone:501-278-9904
Mailing Address - Fax:501-278-9906
Practice Address - Street 1:400 SOUTH MAIN SUITE 500
Practice Address - Street 2:HEALING HANDS THERAPY
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143
Practice Address - Country:US
Practice Address - Phone:501-278-9904
Practice Address - Fax:501-278-9906
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR183977721Medicaid