Provider Demographics
NPI:1821031857
Name:HARDIE, SANDRA (CADCIII, CCSII)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HARDIE
Suffix:
Gender:F
Credentials:CADCIII, CCSII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 NIAGARA AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4128
Mailing Address - Country:US
Mailing Address - Phone:920-451-8667
Mailing Address - Fax:
Practice Address - Street 1:314 NIAGARA AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4128
Practice Address - Country:US
Practice Address - Phone:920-451-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1149101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39391900Medicaid