Provider Demographics
NPI:1568778439
Name:GAGE, SANDRA J (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:J
Last Name:GAGE
Suffix:
Gender:F
Credentials:MA, LPC
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Mailing Address - Street 1:4343 MILETUS DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6820
Mailing Address - Country:US
Mailing Address - Phone:314-780-1446
Mailing Address - Fax:314-830-4313
Practice Address - Street 1:3466 BRIDGELAND DR
Practice Address - Street 2:208
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2606
Practice Address - Country:US
Practice Address - Phone:314-780-1446
Practice Address - Fax:314-830-4313
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO002603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional