Healthcare Provider Details

I. General information

NPI: 1689065112
Provider Name (Legal Business Name): LINDA GAIL SANDNESS BA. NCACII LAT LAT-1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 COUNTY RD 109
EVANSTON WY
82930-2543
US

IV. Provider business mailing address

1013 WEST CHEYENNE DRIVE SUITE A
EVANSTON WY
82930-2543
US

V. Phone/Fax

Practice location:
  • Phone: 307-783-1018
  • Fax: 307-783-1028
Mailing address:
  • Phone: 307-783-1018
  • Fax: 307-783-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAT-199
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: