Provider Demographics
NPI:1437917226
Name:SANDUSKY, ISABELLA LUCIA (LMHCA)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:LUCIA
Last Name:SANDUSKY
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:ISABELLA
Other - Middle Name:LUCIA
Other - Last Name:BRICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHCA
Mailing Address - Street 1:5104 W NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2029
Mailing Address - Country:US
Mailing Address - Phone:253-878-8266
Mailing Address - Fax:
Practice Address - Street 1:3157 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-5136
Practice Address - Country:US
Practice Address - Phone:509-838-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61507641101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health