Provider Demographics
NPI:1326264094
Name:SANFORD, COURTNEY ROMERO (MS, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ROMERO
Last Name:SANFORD
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 1:23130 ELBERTA LN
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-6013
Mailing Address - Country:US
Mailing Address - Phone:225-241-1011
Mailing Address - Fax:225-658-5355
Practice Address - Street 1:23130 ELBERTA LN
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-6013
Practice Address - Country:US
Practice Address - Phone:225-241-1011
Practice Address - Fax:225-658-5355
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist