Provider Demographics
NPI:1780836593
Name:SANDERS, JOHNNY L (MA, CCC-A, FAAA)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:L
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MA, CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 CORNISH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-4304
Mailing Address - Country:US
Mailing Address - Phone:713-206-4577
Mailing Address - Fax:337-233-9973
Practice Address - Street 1:1232 CAMELLIA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6973
Practice Address - Country:US
Practice Address - Phone:337-235-5437
Practice Address - Fax:337-233-9973
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5862237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5862OtherLBESPA