Provider Information for 1396274056
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SHELLY D SANDERS LCSW
Sex: Female
NPI: 1396274056
Last Updated: 2020-06-09
Certification Date: 2020-06-09
Certification Date: 2020-06-09
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1396274056 | ||||||||||||
| Enumeration Date | 2017-06-07 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1620 NORTHWEST BLVD STE 101 COEUR D ALENE, ID 83814-2488 United States Phone: 208-512-5085 | Fax:800-865-1927 | ||||||||||||
| Primary Practice Address | 1620 NORTHWEST BLVD STE 101 COEUR D ALENE, ID 83814-2488 United States Phone: 208-512-5085 | Fax:800-865-1927 | ||||||||||||
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