Provider Demographics
NPI:1376261149
Name:SANDERS, SUZANNE R
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:R
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 N RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:OH
Mailing Address - Zip Code:44837-1012
Mailing Address - Country:US
Mailing Address - Phone:567-560-7731
Mailing Address - Fax:
Practice Address - Street 1:130 SHADY LANE DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2710
Practice Address - Country:US
Practice Address - Phone:567-560-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician