Provider Demographics
NPI:1649607193
Name:RILEY SANFORD, SARITA N (MA, MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SARITA
Middle Name:N
Last Name:RILEY SANFORD
Suffix:
Gender:F
Credentials:MA, 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 1:2104 SEMINOLE TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-5732
Mailing Address - Country:US
Mailing Address - Phone:501-831-3737
Mailing Address - Fax:
Practice Address - Street 1:8109 I 30
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4840
Practice Address - Country:US
Practice Address - Phone:501-562-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#3516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist