Basic Information
| Provider Information | |||||||||
| NPI: | 1710190731 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANFORD | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | WYNNE | ||||||||
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| Credential: | MA, CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7359 267TH ST. NW | ||||||||
| Address2: | SUITE A | ||||||||
| City: | STANWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606296554 | ||||||||
| FaxNumber: | 3606295454 | ||||||||
| Practice Location | |||||||||
| Address1: | 7359 267TH ST. NW | ||||||||
| Address2: | SUITE A | ||||||||
| City: | STANWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606296554 | ||||||||
| FaxNumber: | 3606295454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 2140 | WA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.