Provider Demographics
NPI:1811732175
Name:SANDERS, ROSALIE GWENDOLYN (LPC)
Entity type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:GWENDOLYN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5578 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-9508
Mailing Address - Country:US
Mailing Address - Phone:208-841-2238
Mailing Address - Fax:
Practice Address - Street 1:5578 CHERRY LN
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9508
Practice Address - Country:US
Practice Address - Phone:208-841-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional