Provider Demographics
NPI:1710190731
Name:SANFORD, TERRY WYNNE (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:WYNNE
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7359 267TH ST. NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292
Mailing Address - Country:US
Mailing Address - Phone:360-629-6554
Mailing Address - Fax:360-629-5454
Practice Address - Street 1:7359 267TH ST. NW
Practice Address - Street 2:SUITE A
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292
Practice Address - Country:US
Practice Address - Phone:360-629-6554
Practice Address - Fax:360-629-5454
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2140231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist