Provider Demographics
NPI:1841731494
Name:SANDERS, OLIVIA CATHERINE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:CATHERINE
Last Name:SANDERS
Suffix:
Gender:F
Credentials: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 1:239 ASHTON CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-8597
Mailing Address - Country:US
Mailing Address - Phone:270-634-2270
Mailing Address - Fax:270-634-2270
Practice Address - Street 1:239 ASHTON CT
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-8597
Practice Address - Country:US
Practice Address - Phone:270-634-2270
Practice Address - Fax:270-634-2270
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist