Provider Demographics
NPI:1659576676
Name:SHIELDS, SANDRA ELIZABETH (MSW, LICSW, BCD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MSW, LICSW, BCD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:ELIZABETH
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW, BCD
Mailing Address - Street 1:PO BOX 11486
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-5486
Mailing Address - Country:US
Mailing Address - Phone:206-780-6747
Mailing Address - Fax:
Practice Address - Street 1:175 PARFITT WAY SW
Practice Address - Street 2:SUITE N250
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2584
Practice Address - Country:US
Practice Address - Phone:206-780-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000087101041C0700X
CALCS154131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical