Provider Demographics
NPI:1073805404
Name:LIPFORD SANDERS, JO-ANN (PHD)
Entity Type:Individual
Prefix:
First Name:JO-ANN
Middle Name:
Last Name:LIPFORD SANDERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JO-ANN
Other - Middle Name:
Other - Last Name:LIPFORD SANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0883
Mailing Address - Country:US
Mailing Address - Phone:419-448-2312
Mailing Address - Fax:
Practice Address - Street 1:128 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-2701
Practice Address - Country:US
Practice Address - Phone:419-448-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3072251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health