Provider Demographics
NPI:1477855542
Name:SANDERS, STACY CHRISTINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:CHRISTINE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14616 WAYFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-7809
Mailing Address - Country:US
Mailing Address - Phone:580-656-5571
Mailing Address - Fax:
Practice Address - Street 1:14616 WAYFIELD CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-7809
Practice Address - Country:US
Practice Address - Phone:580-656-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2256235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist