Provider Demographics
NPI:1376783415
Name:CATLIN, SANDRA MARIE (MSED, CCC/L-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIE
Last Name:CATLIN
Suffix:
Gender:F
Credentials:MSED, CCC/L-SLP
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:MARIE
Other - Last Name:GRANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, CCC/L-SLP
Mailing Address - Street 1:762 56 ROAD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12138
Mailing Address - Country:US
Mailing Address - Phone:518-378-7812
Mailing Address - Fax:518-286-2331
Practice Address - Street 1:762 56 ROAD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:NY
Practice Address - Zip Code:12138
Practice Address - Country:US
Practice Address - Phone:518-378-7812
Practice Address - Fax:518-286-2331
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009773-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist