Provider Demographics
NPI:1629112081
Name:ZENNER, SANDRA B (MS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:B
Last Name:ZENNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:B
Other - Last Name:ZENNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:521 NE 452 ST
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32680-3871
Mailing Address - Country:US
Mailing Address - Phone:352-542-7716
Mailing Address - Fax:
Practice Address - Street 1:521 NE 452 ST
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:FL
Practice Address - Zip Code:32680-3871
Practice Address - Country:US
Practice Address - Phone:352-542-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist