Provider Demographics
NPI:1750783965
Name:SANDERS, EMILY ADRIANE (PSYD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ADRIANE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3789
Mailing Address - Country:US
Mailing Address - Phone:515-240-3599
Mailing Address - Fax:
Practice Address - Street 1:2335 70TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4825
Practice Address - Country:US
Practice Address - Phone:515-240-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001319103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical