Provider Demographics
NPI:1417997149
Name:SANDUSKY, GLENIS MELAINE (MSW,CMSW)
Entity Type:Individual
Prefix:MS
First Name:GLENIS
Middle Name:MELAINE
Last Name:SANDUSKY
Suffix:
Gender:F
Credentials:MSW,CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 SPRINGBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3605
Mailing Address - Country:US
Mailing Address - Phone:937-268-6511
Mailing Address - Fax:937-267-3901
Practice Address - Street 1:7151 SPRINGBORO PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3605
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:937-267-3901
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCSW0000006608OtherMEDICAL SOCIAL WORKER