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NPI Code Detail

MEDICARE: MRS. SANDRA M COLLIER MSW, LCSW

MEDICARE: MRS. SANDRA M COLLIER MSW, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker2007014404MO
21041C0700XClinical Social Worker149014209IL

General Provider Information

NPI Number : 1598996324
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SANDRA M COLLIER MSW, LCSW
Provider Business Mailing Address
First Line : 203 GLENLAKE DR
Second Line :
City : GLEN CARBON
State : IL
Zip : 62034-1112
Country : US
Telephone Number : 618-288-5497
Fax Number : 618-288-5403
Provider Business Practice Location Address
First Line : 505 S 8TH ST
Second Line :
City : EAST SAINT LOUIS
State : IL
Zip : 62201-2919
Country : US
Telephone Number : 618-482-7330
Fax Number : 618-482-7639
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2009
Last Update Date : 04/05/2011

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