Provider Demographics
NPI:1114082526
Name:LOON, SANDRA GAY (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:GAY
Last Name:LOON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 SOUTH LINCOLN
Mailing Address - Street 2:
Mailing Address - City:SMITH CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:66967
Mailing Address - Country:US
Mailing Address - Phone:785-282-3343
Mailing Address - Fax:
Practice Address - Street 1:783 7TH STREET
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:KS
Practice Address - Zip Code:67661
Practice Address - Country:US
Practice Address - Phone:785-543-5284
Practice Address - Fax:785-543-5285
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 25151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS070616OtherBCBS
KS070616Medicare ID - Type Unspecified