Provider Demographics
NPI:1215362033
Name:SANDERS, MONA CHRISTINE DRAKE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:CHRISTINE DRAKE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:CHRISTINE
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:201 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-9622
Mailing Address - Country:US
Mailing Address - Phone:740-377-2756
Mailing Address - Fax:
Practice Address - Street 1:201 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-9622
Practice Address - Country:US
Practice Address - Phone:740-377-2756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8561235Z00000X
OH12418235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist