Provider Demographics
NPI:1326474057
Name:SEDERSTROM, SALLY (MBA, MS, NCC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:SEDERSTROM
Suffix:
Gender:F
Credentials:MBA, MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 S BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1635
Mailing Address - Country:US
Mailing Address - Phone:541-410-9908
Mailing Address - Fax:
Practice Address - Street 1:3325 S BERNARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-1635
Practice Address - Country:US
Practice Address - Phone:541-410-9908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health