Provider Demographics
NPI:1265453096
Name:ANDERSON, SANDRA M (AUDCCC-A)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AUDCCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2001
Practice Address - Street 1:624 QUAKER LN
Practice Address - Street 2:SUITE 208C
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3832
Practice Address - Country:US
Practice Address - Phone:336-802-2085
Practice Address - Fax:336-802-2086
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4855231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404192Medicaid
NC640003894OtherRR MEDICARE
2520965Medicare ID - Type Unspecified
NC3404192Medicaid