Healthcare Provider Details

I. General information

NPI: 1548178122
Provider Name (Legal Business Name): LORI ANN SANDERS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 W CAPITOL DR
MILWAUKEE WI
53216-2040
US

IV. Provider business mailing address

2840 N 82ND ST
MILWAUKEE WI
53222-4814
US

V. Phone/Fax

Practice location:
  • Phone: 414-393-3196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number3590003629
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: