Individual
MARK SANDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
118 E JEFFERSON ST, VIROQUA, WI 54665-1613
(608) 632-3286
Mailing address
PO BOX 11, VIROQUA, WI 54665-0011
(608) 632-3286
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
9208-123
WI
Other
Enumeration date
02/17/2017
Last updated
02/13/2020
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