Provider Demographics
NPI:1265280432
Name:HARPER, SANDRA (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HARPER
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 1:2190 JULIE AVE # 54656
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-8816
Mailing Address - Country:US
Mailing Address - Phone:608-466-0421
Mailing Address - Fax:
Practice Address - Street 1:2190 JULIE AVE # 54656
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-8816
Practice Address - Country:US
Practice Address - Phone:608-466-0421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7738-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical