Provider Demographics
NPI:1043510613
Name:VOLLMER, SANDRA LYN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYN
Last Name:VOLLMER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 CENTER PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83211-5365
Mailing Address - Country:US
Mailing Address - Phone:208-406-6011
Mailing Address - Fax:
Practice Address - Street 1:732 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3748
Practice Address - Country:US
Practice Address - Phone:208-478-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-29910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID101Y0800XMedicaid