Provider Demographics
NPI:1407064272
Name:RENFRO, SANDRA LEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:RENFRO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9005 FANITA RANCHO RD
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3949
Mailing Address - Country:US
Mailing Address - Phone:619-562-1863
Mailing Address - Fax:619-562-1863
Practice Address - Street 1:251 LANDIS AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2629
Practice Address - Country:US
Practice Address - Phone:619-498-8450
Practice Address - Fax:619-498-8453
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist