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Individual

MRS. SANDRA SUE PANKONIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
SOCIAL WORKER

Contact information

Practice address
206 W. WADE STREET, ROCHESTER, WI 53167
(262) 210-5004
Mailing address
206 W. WADE STREET, ROCHESTER, WI 53167
(262) 210-5004

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
8603-120
WI

Other

Enumeration date
08/28/2012
Last updated
08/28/2012
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