Provider Demographics
NPI:1063679629
Name:MARSH, SANDRA DEE (CCC SLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DEE
Last Name:MARSH
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6775 KINGS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA
Mailing Address - State:NY
Mailing Address - Zip Code:14767
Mailing Address - Country:US
Mailing Address - Phone:716-782-4013
Mailing Address - Fax:
Practice Address - Street 1:6775 KINGS CORNERS RD
Practice Address - Street 2:
Practice Address - City:PANAMA
Practice Address - State:NY
Practice Address - Zip Code:14767
Practice Address - Country:US
Practice Address - Phone:716-782-4013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0054711235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist