Provider Demographics
NPI:1033285002
Name:GANAS, SANDRA M (MED CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:M
Last Name:GANAS
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WILD BLUEBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-5682
Mailing Address - Country:US
Mailing Address - Phone:850-376-8647
Mailing Address - Fax:
Practice Address - Street 1:1995 MONTURA VW UNIT 203
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-6542
Practice Address - Country:US
Practice Address - Phone:719-602-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6425235Z00000X
CO0002405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886040800Medicaid