Provider Demographics
NPI:1477838381
Name:SANDERS, RONDA (CCC, SLP)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 COOK STILL RD
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:GA
Mailing Address - Zip Code:31060-4006
Mailing Address - Country:US
Mailing Address - Phone:478-979-0750
Mailing Address - Fax:
Practice Address - Street 1:1112 PLAZA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-9009
Practice Address - Country:US
Practice Address - Phone:478-374-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004765235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP004765OtherSTATE LICENSE