Provider Demographics
NPI:1982954301
Name:STEWART-SANDUSKY, MICHELLE RAYE (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RAYE
Last Name:STEWART-SANDUSKY
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:RAYE
Other - Last Name:STEWART-SANDUSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:4725 MERLE HAY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1983
Mailing Address - Country:US
Mailing Address - Phone:515-528-8135
Mailing Address - Fax:515-777-1210
Practice Address - Street 1:4725 MERLE HAY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-1983
Practice Address - Country:US
Practice Address - Phone:515-528-8135
Practice Address - Fax:515-777-1210
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000368106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist