Provider Demographics
NPI:1467456087
Name:FARNUM, SANDRA D (MS CCC-A)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:D
Last Name:FARNUM
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3043
Mailing Address - Country:US
Mailing Address - Phone:802-223-6119
Mailing Address - Fax:802-223-3054
Practice Address - Street 1:58 E STATE ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3043
Practice Address - Country:US
Practice Address - Phone:802-223-6119
Practice Address - Fax:802-223-3054
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT063-0000002231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist