Provider Demographics
NPI:1134376346
Name:FLETCHER, SANDY JO (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:JO
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 THUNDER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:AZ
Mailing Address - Zip Code:85611-8622
Mailing Address - Country:US
Mailing Address - Phone:207-712-4689
Mailing Address - Fax:
Practice Address - Street 1:47 THUNDER MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:AZ
Practice Address - Zip Code:85611-8622
Practice Address - Country:US
Practice Address - Phone:207-712-4689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1786104100000X
MELC103391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker