| Doctor Name: | SANDRA D LANE |
| NPI Number: | 1316248057 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CISW |
| License Number: | 993-122 |
| Business Practice Address: | 21 West Omaha Street Northland Counseling Services Washburn, WI - 548914402 |
| Business Phone Number: | 7153730160 |
| Business Fax Number: | 7153730162 |
| Mailing Address: | Po Box 36, 21 West Omaha Street WASHBURN |
| State: | WI |
| Postal Code: | 548914402 |
| Phone Number: | 7153730160 |
| Fax Number: | 7153730162 |
| NPI Enumeration Date: | 11/11/2010 |
| NPI Last Update Date: | 11/11/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 993-122 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |