Provider Demographics
NPI:1598996324
Name:COLLIER, SANDRA M (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:M
Last Name:COLLIER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 GLENLAKE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1112
Mailing Address - Country:US
Mailing Address - Phone:618-288-5497
Mailing Address - Fax:618-288-5403
Practice Address - Street 1:505 S 8TH ST
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-2919
Practice Address - Country:US
Practice Address - Phone:618-482-7330
Practice Address - Fax:618-482-7639
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070144041041C0700X
IL1490142091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical