Provider Demographics
NPI:1508995630
Name:PAULSEN, SANDRA TAYLOR (MA, LLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:TAYLOR
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9437 SHADY DR
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:MI
Mailing Address - Zip Code:49287-8722
Mailing Address - Country:US
Mailing Address - Phone:517-431-3222
Mailing Address - Fax:
Practice Address - Street 1:4650 W US HIGHWAY 223
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8494
Practice Address - Country:US
Practice Address - Phone:517-266-2588
Practice Address - Fax:517-266-0224
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009604103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling