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General NPI Number Information
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NPI Number | 1659576676
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Entity Type | Individual
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Provider Name | SANDRA ELIZABETH SHIELDS MSW, LICSW, BCD
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Gender | Female
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 12/23/2008
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Provider Practice Location Address
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Address Line | 175 PARFITT WAY SW SUITE N250
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-2584
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Country | US
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Telephone | 206-780-6747
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11486
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-5486
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Country | US
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Telephone | 206-780-6747
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Fax |
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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 | LW00008710
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS15413
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License Number State | CA
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