Provider Demographics
NPI:1790344786
Name:SANDSTROM, RAINAH
Entity Type:Individual
Prefix:
First Name:RAINAH
Middle Name:
Last Name:SANDSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 W BAKERVIEW RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8180
Mailing Address - Country:US
Mailing Address - Phone:360-378-9500
Mailing Address - Fax:
Practice Address - Street 1:414 W BAKERVIEW RD STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8180
Practice Address - Country:US
Practice Address - Phone:360-378-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB60972686106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst