Provider Demographics
NPI:1851915920
Name:SANCER, LYDIA NOELLE (AUD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:NOELLE
Last Name:SANCER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 LOON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-3381
Mailing Address - Country:US
Mailing Address - Phone:940-368-0719
Mailing Address - Fax:
Practice Address - Street 1:5104 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4835
Practice Address - Country:US
Practice Address - Phone:817-717-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81132231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist