Provider Demographics
NPI:1255151452
Name:SANDUSKY, MIKAYLA (MS CF SLP)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:SANDUSKY
Suffix:
Gender:F
Credentials:MS CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 IVES DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS NATIONAL PARK
Mailing Address - State:AR
Mailing Address - Zip Code:71913-9837
Mailing Address - Country:US
Mailing Address - Phone:870-818-7886
Mailing Address - Fax:
Practice Address - Street 1:370 FOLKSTONE RD
Practice Address - Street 2:
Practice Address - City:HOLLY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:28445-7548
Practice Address - Country:US
Practice Address - Phone:910-455-2448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist