Provider Demographics
NPI:1013558600
Name:BRODERWAY, SANDRA KAYE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KAYE
Last Name:BRODERWAY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35080-0058
Mailing Address - Country:US
Mailing Address - Phone:844-687-5465
Mailing Address - Fax:844-687-5465
Practice Address - Street 1:5112 SHAMROCK DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080-3390
Practice Address - Country:US
Practice Address - Phone:844-687-5465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist