Provider Demographics
NPI:1619019973
Name:BOATMAN, SANDRA ELIZABETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:BOATMAN
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 1:8332 WINDSOR VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-4939
Mailing Address - Country:US
Mailing Address - Phone:501-834-1283
Mailing Address - Fax:
Practice Address - Street 1:207 FRED RAINS DR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5457
Practice Address - Country:US
Practice Address - Phone:501-834-0217
Practice Address - Fax:501-833-0957
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR715235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist