| Doctor Name: | SANDRA LEE MITTELSTEADT |
| NPI Number: | 1104096189 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 4398 |
| Business Practice Address: | 1095 Midway Rd Menasha, WI - 549521115 |
| Business Phone Number: | 9207202300 |
| Business Fax Number: | 9207203719 |
| Mailing Address: | 1095 Midway Rd, MENASHA |
| State: | WI |
| Postal Code: | 549521115 |
| Phone Number: | 9207203700 |
| Fax Number: | 9207203806 |
| NPI Enumeration Date: | 03/06/2008 |
| NPI Last Update Date: | 09/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 4398 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |