Healthcare Provider Details

I. General information

NPI: 1639716962
Provider Name (Legal Business Name): WENDY SANDOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 S TACOMA WAY
TACOMA WA
98409-3134
US

IV. Provider business mailing address

15 OREGON AVE STE 308
TACOMA WA
98409-7462
US

V. Phone/Fax

Practice location:
  • Phone: 253-300-7474
  • Fax:
Mailing address:
  • Phone: 253-304-7753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP00051813
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: