Provider Demographics
NPI:1427333871
Name:EWING, SANDRA MILENA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MILENA
Last Name:EWING
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 SCOTTSMAN DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4656
Mailing Address - Country:US
Mailing Address - Phone:972-767-7658
Mailing Address - Fax:
Practice Address - Street 1:1203 SCOTTSMAN DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4656
Practice Address - Country:US
Practice Address - Phone:972-767-7658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105344235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist