Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | PPC-953 | WY |
Y | 103TS0200X | School Psychologist | PTSB70891 | WY |
NPI | 1013451863 |
---|---|
Provider Name | Sandra Sanderson |
First Address | Afton, WY 83110-1527 |
Second Address | Jackson, WY 83001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2016 |
Last Update Date | 26/12/2019 |