Individual
SANDRA COOK-FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3710 CENTRAL AVE STE 9, KEARNEY, NE 68847-8126
(308) 251-2222
(308) 382-5315
Mailing address
2608 OLD FAIR RD, GRAND ISLAND, NE 68803-5271
(308) 382-5297
(308) 382-5315
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
953
NE
1041C0700X
Clinical Social Worker
560
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025173100
—
NE
05
—
10026194400
—
NE
Enumeration date
05/12/2014
Last updated
06/12/2020
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