Provider Demographics
NPI:1902187891
Name:MILLER, SANDRA DEE (MSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:DEE
Last Name:MILLER
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 1:2801 ROYAL OAK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5897
Mailing Address - Country:US
Mailing Address - Phone:573-355-0531
Mailing Address - Fax:
Practice Address - Street 1:2801 ROYAL OAK CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5897
Practice Address - Country:US
Practice Address - Phone:573-355-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110230971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical