Provider Demographics
NPI:1417734401
Name:SANDAU, ASHLEY MARIE
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MARIE
Last Name:SANDAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8909
Mailing Address - Country:US
Mailing Address - Phone:208-420-7070
Mailing Address - Fax:
Practice Address - Street 1:119 N COMMERCIAL ST STE 1400
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4437
Practice Address - Country:US
Practice Address - Phone:360-734-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61480459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health