Provider Demographics
NPI:1083156756
Name:SAUNDERS, CHARLENE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:SAUNDERS
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 1:460 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:KY
Mailing Address - Zip Code:42170-9738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:460 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:KY
Practice Address - Zip Code:42170-9738
Practice Address - Country:US
Practice Address - Phone:270-529-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-13
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY170479235Z00000X
TN5186235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist