Provider Demographics
NPI:1023360153
Name:WATERS, SANDRA SUE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:SUE
Last Name:WATERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21110 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-4976
Mailing Address - Country:US
Mailing Address - Phone:281-259-0963
Mailing Address - Fax:
Practice Address - Street 1:16835 DEER CREEK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4968
Practice Address - Country:US
Practice Address - Phone:281-379-4373
Practice Address - Fax:281-655-0762
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-13
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13440235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist