Provider Demographics
NPI:1427568039
Name:SANDER, EMILY SARAH (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:SARAH
Last Name:SANDER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:SARAH
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:55 E. 120TH STREET
Mailing Address - Street 2:ROOM 210
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035
Mailing Address - Country:US
Mailing Address - Phone:212-369-3134
Mailing Address - Fax:
Practice Address - Street 1:55 E. 120TH STREET
Practice Address - Street 2:ROOM 210
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:212-369-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028170235Z00000X
NY028170-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty