Individual
MRS. SANDI GREENE DEFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
175 S MAIN ST, CANTON, IL 61520-2670
(309) 647-0201
(309) 647-9762
Mailing address
175 S MAIN ST, CANTON, IL 61520-2670
(309) 647-0201
(309) 647-9762
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
147000582
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203356810
TAX ID
—
Enumeration date
03/07/2007
Last updated
07/10/2019
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