Provider Demographics
NPI:1467474304
Name:SANFORD, JOYCE ELIZABETH (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:ELIZABETH
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1116 NORTH ST
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-4046
Mailing Address - Country:US
Mailing Address - Phone:765-714-2500
Mailing Address - Fax:765-269-9907
Practice Address - Street 1:1116 NORTH ST
Practice Address - Street 2:APARTMENT A
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-4046
Practice Address - Country:US
Practice Address - Phone:765-714-2500
Practice Address - Fax:765-269-9907
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN22003609A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200498350AMedicaid
IN200723140AMedicaid