Provider Demographics
NPI:1649413899
Name:CHANDLER, SARAH MARIE (AUD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:ROTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:6744 CLAYTON RD STE 310
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1639
Mailing Address - Country:US
Mailing Address - Phone:367-660-0314
Mailing Address - Fax:
Practice Address - Street 1:6744 CLAYTON RD STE 310
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1639
Practice Address - Country:US
Practice Address - Phone:367-660-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004012719231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2004012719OtherSTATE LICENSE
MO339480808Medicaid