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NPI Code Detail

MEDICARE: DR. SANDRA LOTSHAW MICKEN PH.D.

MEDICARE: DR. SANDRA LOTSHAW MICKEN PH.D.
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
1103T00000XPsychologist2017008168MO

General Provider Information

NPI Number : 1851431407
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDRA LOTSHAW MICKEN PH.D.
Provider Business Mailing Address
First Line : 3687 VETERANS DR
Second Line :
City : FORT HARRISON
State : MT
Zip : 59636-9700
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3687 VETERANS DR
Second Line :
City : FORT HARRISON
State : MT
Zip : 59636-9700
Country : US
Telephone Number : 406-447-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 11/25/2019

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