Provider Demographics
NPI:1700910163
Name:DRENGACZ, SANDRA R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:R
Last Name:DRENGACZ
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 1:20 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3535
Mailing Address - Country:US
Mailing Address - Phone:541-484-4428
Mailing Address - Fax:541-484-7212
Practice Address - Street 1:20 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3535
Practice Address - Country:US
Practice Address - Phone:541-484-4428
Practice Address - Fax:541-484-7212
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical