| Doctor Name: | SANDY ETIGSON |
| NPI Number: | 1841404605 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 2458 |
| Business Practice Address: | 249 White Mountain Dr Mescalero, NM - 883409622 |
| Business Phone Number: | 5054644431 |
| Business Fax Number: | 5054644822 |
| Mailing Address: | 249 White Mountain Dr, MESCALERO |
| State: | NM |
| Postal Code: | 883409622 |
| Phone Number: | 5054644431 |
| Fax Number: | 5054644822 |
| NPI Enumeration Date: | 05/10/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 2458 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |