Individual
KELLY SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
1691 E US 23 STE 4, EAST TAWAS, MI 48730-9337
(989) 479-7550
Mailing address
3781 S CRUZEN RD, MIKADO, MI 48745-8761
(989) 335-3942
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101001457
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100462120
—
IN
Enumeration date
03/23/2007
Last updated
07/25/2023
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