Provider Demographics
NPI:1104258177
Name:DAUGHERTY, SAUNDRA (SLP)
Entity type:Individual
Prefix:MRS
First Name:SAUNDRA
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3301
Mailing Address - Country:US
Mailing Address - Phone:636-227-0506
Mailing Address - Fax:
Practice Address - Street 1:317 OZARK TRAIL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2191
Practice Address - Country:US
Practice Address - Phone:636-227-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist