Provider Demographics
NPI:1689065112
Name:SANDNESS, LINDA GAIL (BA NCACII LAT LAT-1)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:GAIL
Last Name:SANDNESS
Suffix:
Gender:F
Credentials:BA NCACII LAT LAT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1013 WEST CHEYENNE DRIVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-2543
Mailing Address - Country:US
Mailing Address - Phone:307-783-1018
Mailing Address - Fax:307-783-1028
Practice Address - Street 1:77 COUNTY RD 109
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-2543
Practice Address - Country:US
Practice Address - Phone:307-783-1018
Practice Address - Fax:307-783-1028
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLAT-199101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)