Individual
MRS. SANDRA JEAN MATHES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
210 N SHAMROCK BLVD, RUSSELLVILLE, AR 72802
(501) 303-3105
Mailing address
210 N SHAMROCK BLVD, RUSSELLVILLE, AR 72802-9658
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
169-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116399726
—
AR
Enumeration date
09/09/2008
Last updated
07/19/2018
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