Provider Demographics
NPI:1376093146
Name:SANDS, SHELLEY ANNETTE (CSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANNETTE
Last Name:SANDS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 WILKINS CIR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1336
Mailing Address - Country:US
Mailing Address - Phone:307-237-1800
Mailing Address - Fax:307-265-7277
Practice Address - Street 1:815 S CENTER ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3730
Practice Address - Country:US
Practice Address - Phone:307-333-1301
Practice Address - Fax:307-333-5436
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCSW-2651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical