Provider Demographics
NPI:1598084253
Name:SANDERS, KATELIN LEANN (SLPA)
Entity Type:Individual
Prefix:
First Name:KATELIN
Middle Name:LEANN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15358 W. ELLSWORTH DR.
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401
Mailing Address - Country:US
Mailing Address - Phone:720-299-2432
Mailing Address - Fax:
Practice Address - Street 1:15358 W ELLSWORTH DR
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5053
Practice Address - Country:US
Practice Address - Phone:720-299-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COKS1128OtherSLPA/ABA LINE STAFF