Individual
MRS. SANDRA L PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M. ED
Contact information
Practice address
2624 9TH AVE S, FARGO, ND 58103-2350
(701) 298-4500
(701) 298-4400
Mailing address
2624 9TH AVE S, FARGO, ND 58103-2350
(701) 298-4500
(701) 298-4400
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1440
ND
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017919
BCBS OF ND PIN
ND
Enumeration date
10/09/2007
Last updated
09/23/2020
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