Provider Demographics
NPI:1407089857
Name:REYNOLDS, SANDRA GAIL (MSCCC/SOLP)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:GAIL
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MSCCC/SOLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5659 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THELMA
Mailing Address - State:KY
Mailing Address - Zip Code:41260-8609
Mailing Address - Country:US
Mailing Address - Phone:606-788-6600
Mailing Address - Fax:606-788-7076
Practice Address - Street 1:5659 MAIN ST
Practice Address - Street 2:
Practice Address - City:THELMA
Practice Address - State:KY
Practice Address - Zip Code:41260-8609
Practice Address - Country:US
Practice Address - Phone:606-788-6600
Practice Address - Fax:606-788-7076
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY673235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist