Provider Demographics
NPI:1912337189
Name:HERZOG, SANDRA KAYE (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KAYE
Last Name:HERZOG
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 MUD HOUSE RD NE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8719
Mailing Address - Country:US
Mailing Address - Phone:740-681-1524
Mailing Address - Fax:
Practice Address - Street 1:2636 MUD HOUSE RD NE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8719
Practice Address - Country:US
Practice Address - Phone:740-681-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-4566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist