Healthcare Provider Details

I. General information

NPI: 1740038827
Provider Name (Legal Business Name): SANDRA ANDERSEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7192 W POTOMAC DR
BOISE ID
83704-9147
US

IV. Provider business mailing address

1707 E WARM SPRINGS AVE
BOISE ID
83712-8144
US

V. Phone/Fax

Practice location:
  • Phone: 208-489-8311
  • Fax:
Mailing address:
  • Phone: 208-365-8024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-41838
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: