Provider Demographics
NPI:1255581765
Name:FONTECCHIO, SANDI HOPPER (AUD)
Entity type:Individual
Prefix:
First Name:SANDI
Middle Name:HOPPER
Last Name:FONTECCHIO
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 1:4790 EXECUTIVE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1606
Mailing Address - Country:US
Mailing Address - Phone:636-441-3100
Mailing Address - Fax:
Practice Address - Street 1:4790 EXECUTIVE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1606
Practice Address - Country:US
Practice Address - Phone:636-441-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008028914231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist