Provider Demographics
NPI:1811257470
Name:BEYER, SANDRA SUE (MA,CCC/SLP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:SUE
Last Name:BEYER
Suffix:
Gender:F
Credentials:MA,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 COURTHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8028
Mailing Address - Country:US
Mailing Address - Phone:717-381-0709
Mailing Address - Fax:
Practice Address - Street 1:604 COURTHOUSE CIR
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-8028
Practice Address - Country:US
Practice Address - Phone:717-381-0709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001110L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist