Provider Demographics
NPI:1154748895
Name:MARTIRE, SANDRA HENDRICKSEN (MS, MBA)
Entity type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:HENDRICKSEN
Last Name:MARTIRE
Suffix:
Gender:F
Credentials:MS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 OBERHAUSEN DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7056
Mailing Address - Country:US
Mailing Address - Phone:701-319-1917
Mailing Address - Fax:701-255-4696
Practice Address - Street 1:630 OBERHAUSEN DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-7056
Practice Address - Country:US
Practice Address - Phone:701-319-1917
Practice Address - Fax:701-255-4696
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist