Provider Demographics
NPI:1972676583
Name:KLINDWORTH, SANDRA OLSON (MS, CCC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:OLSON
Last Name:KLINDWORTH
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9946 LAKEMERE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2617
Mailing Address - Country:US
Mailing Address - Phone:214-503-7637
Mailing Address - Fax:
Practice Address - Street 1:11882 GREENVILLE AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-0586
Practice Address - Country:US
Practice Address - Phone:469-330-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13043235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist