| Doctor Name: | SANDY IMANSE |
| NPI Number: | 1023050382 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | 6801018351 |
| Business Practice Address: | 1411 Lincolnway W Mishawaka, IN - 465441626 |
| Business Phone Number: | 5742555669 |
| Business Fax Number: | 5745372652 |
| Mailing Address: | Po Box 809, GOSHEN |
| State: | IN |
| Postal Code: | 465270809 |
| Phone Number: | 5745331234 |
| Fax Number: | 5745372652 |
| NPI Enumeration Date: | 06/12/2006 |
| NPI Last Update Date: | 02/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 6801018351 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |