| Doctor Name: | MICHELLE MARIE SANDERSON |
| NPI Number: | 1518258110 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC, SAC |
| License Number: | 16214-130 |
| Business Practice Address: | 804 W 9th St N Suite B Ladysmith, WI - 548481267 |
| Business Phone Number: | 7155329771 |
| Business Fax Number: | 7155329774 |
| Mailing Address: | 804 W 9th St N, Suite B LADYSMITH |
| State: | WI |
| Postal Code: | 548481267 |
| Phone Number: | 7155329771 |
| Fax Number: | 7155329774 |
| NPI Enumeration Date: | 04/29/2011 |
| NPI Last Update Date: | 06/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 16214-130 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |