Provider Demographics
NPI:1437283173
Name:BROADHEAD, SANDRA
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:BROADHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4031
Mailing Address - Country:US
Mailing Address - Phone:928-373-3451
Mailing Address - Fax:928-373-3498
Practice Address - Street 1:4250 W 16TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4031
Practice Address - Country:US
Practice Address - Phone:928-373-3451
Practice Address - Fax:928-373-3498
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist