Provider Demographics
NPI:1710120753
Name:THOMAS, SANDRA (MSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 THORNBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-3886
Mailing Address - Country:US
Mailing Address - Phone:260-484-4600
Mailing Address - Fax:260-484-4002
Practice Address - Street 1:5440 THORNBRIAR LN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-3886
Practice Address - Country:US
Practice Address - Phone:260-484-4600
Practice Address - Fax:260-484-4002
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker