Provider Demographics
NPI:1699869354
Name:SANFORD, CHRIS A (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:A
Last Name:SANFORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 S 8TH AVE
Mailing Address - Street 2:MAIL STOP 8116
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83209-8116
Mailing Address - Country:US
Mailing Address - Phone:208-282-3813
Mailing Address - Fax:208-282-4571
Practice Address - Street 1:921 S 8TH AVE
Practice Address - Street 2:MAIL STOP 8116
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209-8116
Practice Address - Country:US
Practice Address - Phone:208-282-3813
Practice Address - Fax:208-282-4571
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-1907231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist