Provider Demographics
NPI:1710926225
Name:KLINKER, SANDRA J (MSW, ACSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:KLINKER
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 E STATE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4700
Mailing Address - Country:US
Mailing Address - Phone:260-471-0632
Mailing Address - Fax:260-471-3451
Practice Address - Street 1:3010 E STATE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4700
Practice Address - Country:US
Practice Address - Phone:260-471-0632
Practice Address - Fax:260-471-3451
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000223A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000185618OtherANTHEM BCBS
IN13378OtherPHP
IN11565855OtherCAQH
IN448673OtherVALUE OPTIONS
IN000000006472OtherMPLAN
IN261505000OtherMAGELLEN