Provider Demographics
NPI:1982810040
Name:ADDY, SANDRA BROOME (MED CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:BROOME
Last Name:ADDY
Suffix:
Gender:F
Credentials:MED CCC SLP
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Mailing Address - Street 1:144 MYRICK RD NW
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-8276
Mailing Address - Country:US
Mailing Address - Phone:478-968-5152
Mailing Address - Fax:478-457-2005
Practice Address - Street 1:144 MYRICK RD NW
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-8276
Practice Address - Country:US
Practice Address - Phone:478-968-5152
Practice Address - Fax:478-457-2005
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GASLP004170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist