Individual
SANDRA M VANDOMELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
9415 W FOREST HOME AVE, SUITE #1, HALES CORNERS, WI 53130-1680
(414) 427-4884
Mailing address
4555 W SCHROEDER DR, SUITE 170, MILWAUKEE, WI 53223-1475
(414) 365-3210
(414) 365-3225
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15463-130
WI
Other
Enumeration date
04/04/2008
Last updated
04/04/2008
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