Individual
SANDRA SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.S
Contact information
Practice address
140 E BROADWAY AVE # 13, JACKSON, WY 83001
(307) 413-6528
Mailing address
PO BOX 1527, AFTON, WY 83110-1527
(307) 413-4276
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PPC-953
WY
103TS0200X
School Psychologist
Primary
PTSB70891
WY
Other
Enumeration date
12/13/2016
Last updated
12/26/2019
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