Provider Demographics
NPI:1891192522
Name:SANDERS, MARILYN A (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:A
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:MARILYN
Other - Middle Name:A
Other - Last Name:HAGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1235 N COVINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6501
Mailing Address - Country:US
Mailing Address - Phone:316-794-3104
Mailing Address - Fax:
Practice Address - Street 1:1235 N COVINGTON ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-6501
Practice Address - Country:US
Practice Address - Phone:316-794-3104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist