Provider Demographics
NPI:1841939949
Name:NELLE, SANDRA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:NELLE
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 1:114 COLIMA ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-1106
Mailing Address - Country:US
Mailing Address - Phone:830-491-1252
Mailing Address - Fax:
Practice Address - Street 1:7 UPPER BALCONES RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8546
Practice Address - Country:US
Practice Address - Phone:210-360-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist