Provider Demographics
NPI:1689795452
Name:GILLIS-ARDEN, SANDRA LYNN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:GILLIS-ARDEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BARE HILL RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5809
Mailing Address - Country:US
Mailing Address - Phone:508-405-0118
Mailing Address - Fax:
Practice Address - Street 1:642 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3302
Practice Address - Country:US
Practice Address - Phone:978-443-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist