Provider Demographics
NPI:1710550769
Name:SANDERS, JENNIFER GRACE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GRACE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4823
Mailing Address - Country:US
Mailing Address - Phone:615-496-4302
Mailing Address - Fax:
Practice Address - Street 1:4731 TROUSDALE DR STE 12
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1360
Practice Address - Country:US
Practice Address - Phone:615-832-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist