Provider Demographics
NPI:1518189216
Name:SANDERS, BRENDA ALANE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:ALANE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-3823
Mailing Address - Country:US
Mailing Address - Phone:409-750-0599
Mailing Address - Fax:
Practice Address - Street 1:308 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-3823
Practice Address - Country:US
Practice Address - Phone:409-750-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101910235Z00000X
OK5220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist