Provider Demographics
NPI:1235456971
Name:SAND, JENNIFER KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KAY
Last Name:SAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:SAND
Other - Last Name:CANALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2700 WESTOWN PKWY STE 425
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1434
Mailing Address - Country:US
Mailing Address - Phone:515-528-2532
Mailing Address - Fax:515-528-2532
Practice Address - Street 1:2700 WESTOWN PKWY STE 425
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1434
Practice Address - Country:US
Practice Address - Phone:515-528-2532
Practice Address - Fax:515-528-2532
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23135103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling