Healthcare Provider Details

I. General information

NPI: 1457778904
Provider Name (Legal Business Name): SANDRA GABER BSW, CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA K SCHAVE

II. Dates (important events)

Enumeration Date: 03/22/2014
Last Update Date: 03/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 ANNEX RD
JEFFERSON WI
53549-9803
US

IV. Provider business mailing address

1541 ANNEX RD
JEFFERSON WI
53549-9803
US

V. Phone/Fax

Practice location:
  • Phone: 920-674-3105
  • Fax: 920-674-7594
Mailing address:
  • Phone: 920-674-3105
  • Fax: 920-674-7594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2728-120
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: