Provider Demographics
NPI:1063553568
Name:SANDERS, ELIZABETH RENEE
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:RENEE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:RENEE
Other - Last Name:BAUMGARTNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:68 SAVANNAH HILL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2252
Mailing Address - Country:US
Mailing Address - Phone:314-486-4443
Mailing Address - Fax:
Practice Address - Street 1:68 SAVANNAH HILL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2252
Practice Address - Country:US
Practice Address - Phone:314-486-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115898235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist