Provider Demographics
NPI:1407429129
Name:VIK, SANDRA L (MSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:VIK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 NE 204TH PL
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-8501
Mailing Address - Country:US
Mailing Address - Phone:260-679-6560
Mailing Address - Fax:
Practice Address - Street 1:20903 70TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7201
Practice Address - Country:US
Practice Address - Phone:425-672-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0000Medicaid