Healthcare Provider Details

I. General information

NPI: 1306531504
Provider Name (Legal Business Name): HEATHER SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5122 GLENCROSSING WAY
CINCINNATI OH
45238-3361
US

IV. Provider business mailing address

531 TUSCANY VALLEY CT APT 12
CRESTVIEW HILLS KY
41017-3447
US

V. Phone/Fax

Practice location:
  • Phone: 513-827-9044
  • Fax:
Mailing address:
  • Phone: 859-640-1839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA183660
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: