Provider Demographics
NPI:1437315322
Name:CLEVENGER, SANDRA LEE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:CLEVENGER
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 1:1664 MILL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT EDEN
Mailing Address - State:KY
Mailing Address - Zip Code:40046-8023
Mailing Address - Country:US
Mailing Address - Phone:502-477-2480
Mailing Address - Fax:502-477-2480
Practice Address - Street 1:1664 MILL RD
Practice Address - Street 2:
Practice Address - City:MOUNT EDEN
Practice Address - State:KY
Practice Address - Zip Code:40046-8023
Practice Address - Country:US
Practice Address - Phone:502-477-2480
Practice Address - Fax:502-477-2480
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator