Provider Demographics
NPI:1245558048
Name:PRIEN, SANDRA L (CSAC,CSW,CCJS,NCGC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:PRIEN
Suffix:
Gender:F
Credentials:CSAC,CSW,CCJS,NCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 W KING ST
Mailing Address - Street 2:PO BOX 876
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3457
Mailing Address - Country:US
Mailing Address - Phone:715-362-5437
Mailing Address - Fax:715-262-2014
Practice Address - Street 1:48 W KING ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3457
Practice Address - Country:US
Practice Address - Phone:715-362-5437
Practice Address - Fax:715-262-2014
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1331-132101YA0400X
WI2769-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI393-37900Medicaid