Provider Demographics
NPI:1801999339
Name:MARTIN-SANFORD, TAMARA PHILANA (MACCCSLPL)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:PHILANA
Last Name:MARTIN-SANFORD
Suffix:
Gender:F
Credentials:MACCCSLPL
Other - Prefix:MRS
Other - First Name:TAMARA
Other - Middle Name:PHILANA
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCCSLPL
Mailing Address - Street 1:4734 S CHAMPLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-1504
Mailing Address - Country:US
Mailing Address - Phone:773-373-0442
Mailing Address - Fax:773-373-0442
Practice Address - Street 1:5820 W IRVING PARK ROAD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634
Practice Address - Country:US
Practice Address - Phone:773-685-8482
Practice Address - Fax:773-685-8479
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist