Provider Demographics
NPI:1114453735
Name:MEHL, SONDRA (MS-CCC SLP)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:
Last Name:MEHL
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 1:64 SANFORD LN
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-2820
Mailing Address - Country:US
Mailing Address - Phone:917-207-5096
Mailing Address - Fax:
Practice Address - Street 1:64 SANFORD LN
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-2820
Practice Address - Country:US
Practice Address - Phone:917-207-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist