Provider Demographics
NPI:1518150903
Name:SANFORD, CHRISTINA (MA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-0445
Mailing Address - Country:US
Mailing Address - Phone:606-748-1719
Mailing Address - Fax:
Practice Address - Street 1:335 CHESTNUT LN
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-9778
Practice Address - Country:US
Practice Address - Phone:859-537-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY07-069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY07-069Medicaid