Provider Demographics
NPI:1023201514
Name:PESSEFALL, SANDRA KAY (LSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:PESSEFALL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 STATE HIGHWAY 108
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-8200
Mailing Address - Country:US
Mailing Address - Phone:419-335-3732
Mailing Address - Fax:
Practice Address - Street 1:7320 STATE HIGHWAY 108
Practice Address - Street 2:SUITE A
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-8200
Practice Address - Country:US
Practice Address - Phone:419-335-3732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00112341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical