Provider Demographics
NPI:1720254683
Name:LARUE, SANDRA ALLISON (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ALLISON
Last Name:LARUE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 LYNNE TER
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4816
Mailing Address - Country:US
Mailing Address - Phone:203-926-0008
Mailing Address - Fax:
Practice Address - Street 1:7003 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1393
Practice Address - Country:US
Practice Address - Phone:203-375-5894
Practice Address - Fax:203-386-1144
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist