Healthcare Provider Details

I. General information

NPI: 1912911306
Provider Name (Legal Business Name): SANDRA KAY WILEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S VALLEY RD 211
PAOLI PA
19301-1450
US

IV. Provider business mailing address

649 S HENDERSON RD D607
KING OF PRUSSIA PA
19406-3529
US

V. Phone/Fax

Practice location:
  • Phone: 484-207-0303
  • Fax:
Mailing address:
  • Phone: 484-207-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014663
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: