Provider Demographics
NPI:1609026269
Name:SANDERS, MIRANDA IRENE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:IRENE
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 1:15 ROSEMARY LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-9186
Mailing Address - Country:US
Mailing Address - Phone:479-567-0133
Mailing Address - Fax:
Practice Address - Street 1:1501 S DETROIT AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-7247
Practice Address - Country:US
Practice Address - Phone:479-968-2084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NH1607235Z00000X
ARSP#2677235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist