Provider Demographics
NPI:1902823826
Name:WILLOUGHBY, SANDRA ELISE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELISE
Last Name:WILLOUGHBY
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 1:130 S BARSTOW ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3691
Mailing Address - Country:US
Mailing Address - Phone:715-833-7600
Mailing Address - Fax:715-833-7116
Practice Address - Street 1:130 S BARSTOW ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3691
Practice Address - Country:US
Practice Address - Phone:715-833-7600
Practice Address - Fax:715-833-7116
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI65851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical