Provider Demographics
NPI:1114934304
Name:TATTERSHALL, SANDRA SUSAN (PHD SLP)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:SUSAN
Last Name:TATTERSHALL
Suffix:
Gender:F
Credentials:PHD SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2101
Mailing Address - Country:US
Mailing Address - Phone:859-525-1570
Mailing Address - Fax:859-525-0823
Practice Address - Street 1:6421 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2101
Practice Address - Country:US
Practice Address - Phone:859-525-1570
Practice Address - Fax:859-525-0823
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 0158235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist