| Doctor Name: | SANDRA MEDINA |
| NPI Number: | 1881884153 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, CSW-PIP, LCSW |
| License Number: | 2210 |
| Business Practice Address: | 122 N 6th St Custer, SD - 577301647 |
| Business Phone Number: | 6056733022 |
| Business Fax Number: | 6056733022 |
| Mailing Address: | 75 Centennial Dr, CUSTER |
| State: | SD |
| Postal Code: | 577309642 |
| Phone Number: | 6056733022 |
| Fax Number: | 6056733022 |
| NPI Enumeration Date: | 08/01/2007 |
| NPI Last Update Date: | 08/01/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2210 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |