MEDICARE: GWENDOLYN LEE SANDERS

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
1	1041C0700X	Clinical Social Worker	64258	TX

General Provider Information

NPI Number	:	1962344119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN LEE SANDERS

Provider Business Mailing Address
First Line	:	4204 JASPER LN
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76049-6605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4204 JASPER LN
Second Line	:
City	:	GRANBURY
State	:	TX
Zip	:	76049-6605
Country	:	US
Telephone Number	:	352-209-1909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ GWENDOLYN LEE SANDERS ” Practice Location

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