Provider Demographics
NPI:1285858357
Name:SANSONE, LYNN
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:SANSONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 KUHL AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-2116
Mailing Address - Country:US
Mailing Address - Phone:636-456-4311
Mailing Address - Fax:636-456-0861
Practice Address - Street 1:302 KUHL AVE
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-2116
Practice Address - Country:US
Practice Address - Phone:636-456-4311
Practice Address - Fax:636-456-0861
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist