Doctor Name: | MS. M FAY SANDERS |
NPI Number: | 1013029560 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | LCSW |
Business Practice Address: | 888 Thackeray Trl Ste 105 Oconomowoc, WI - 530664342 |
Business Phone Number: | 2625423255 |
Business Fax Number: | 2625675451 |
Mailing Address: | 888 Thackeray Trl Ste 105, OCONOMOWOC |
State: | WI |
Postal Code: | 530664342 |
Phone Number: | 2625423255 |
Fax Number: | 2625675451 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LCSW |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |