Provider Demographics
NPI:1295898435
Name:SANDERS, ANGELA DENISE (SLP)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DENISE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 N TREKELL RD
Mailing Address - Street 2:APT 1019
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-1352
Mailing Address - Country:US
Mailing Address - Phone:520-723-6700
Mailing Address - Fax:520-723-7232
Practice Address - Street 1:5656 E. GRANT ROAD
Practice Address - Street 2:STE. 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-723-6700
Practice Address - Fax:520-723-7232
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL5257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ151201Medicaid