Provider Demographics
NPI:1700863669
Name:MILTON, SANDRA ANNE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ANNE
Last Name:MILTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:ANNE
Other - Last Name:EDELSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5601 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406
Mailing Address - Country:US
Mailing Address - Phone:253-752-1860
Mailing Address - Fax:253-752-1890
Practice Address - Street 1:1919 N PEARL ST
Practice Address - Street 2:STE C-1
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406
Practice Address - Country:US
Practice Address - Phone:253-752-1860
Practice Address - Fax:253-752-1890
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000042821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical