Provider Demographics
NPI:1407313695
Name:WARREN, SANDRA LYNN (LHIS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:WARREN
Suffix:
Gender:F
Credentials:LHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 GAITHER ST
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2329
Mailing Address - Country:US
Mailing Address - Phone:336-753-8900
Mailing Address - Fax:336-753-8901
Practice Address - Street 1:189 GAITHER ST
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2329
Practice Address - Country:US
Practice Address - Phone:336-753-8900
Practice Address - Fax:336-753-8901
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1353237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter