Provider Demographics
NPI:1609326354
Name:CAUDILL, SANDRA F
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:F
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:VICCO
Mailing Address - State:KY
Mailing Address - Zip Code:41773-0008
Mailing Address - Country:US
Mailing Address - Phone:606-854-6048
Mailing Address - Fax:
Practice Address - Street 1:48 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9443
Practice Address - Country:US
Practice Address - Phone:606-854-6048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)