Provider Demographics
NPI:1689685364
Name:ANDERSON, SANDRA LYNN (MS LPC NCC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E BUSINESS HIGHWAY 151 STE A-3
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-3875
Mailing Address - Country:US
Mailing Address - Phone:608-348-7474
Mailing Address - Fax:608-348-7117
Practice Address - Street 1:1250 E BUSINESS HIGHWAY 151 STE A-3
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3875
Practice Address - Country:US
Practice Address - Phone:608-348-7474
Practice Address - Fax:608-348-7117
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002900101YM0800X
WI2994125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43580900Medicaid