Provider Demographics
NPI:1598823684
Name:KISER GRIFFITH, SANDI (LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:
Last Name:KISER GRIFFITH
Suffix:
Gender:F
Credentials:LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:KENORA
Mailing Address - State:WV
Mailing Address - Zip Code:25530
Mailing Address - Country:US
Mailing Address - Phone:304-453-2433
Mailing Address - Fax:
Practice Address - Street 1:748 BEECH ST
Practice Address - Street 2:
Practice Address - City:KENORA
Practice Address - State:WV
Practice Address - Zip Code:25530
Practice Address - Country:US
Practice Address - Phone:304-453-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV727103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0165152000Medicaid