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General NPI Number Information
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NPI Number | 1295924009
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Entity Type | Individual
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Provider Name | SANDRA VERONICK MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 760 SW MADISON AVE STE 11B
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City | CORVALLIS
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State | OR
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Zip | 97333-4588
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Country | US
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Telephone | 541-224-6603
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Fax | 541-981-5072
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Provider Business Mailing Address
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Address Line | 760 SW MADISON AVE STE 11B
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City | CORVALLIS
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State | OR
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Zip | 97333-4588
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Country | US
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Telephone | 541-224-6603
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Fax | 541-981-5072
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L4077
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License Number State | OR
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