Provider Demographics
NPI:1902016959
Name:WINDER, SANDRA JOY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JOY
Last Name:WINDER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-1115
Mailing Address - Country:US
Mailing Address - Phone:314-546-3676
Mailing Address - Fax:
Practice Address - Street 1:160 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-1115
Practice Address - Country:US
Practice Address - Phone:314-546-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0011891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical