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General NPI Number Information
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NPI Number | 1669883724
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Entity Type | Individual
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Provider Name | SANDRA COOK-FONG
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Gender | Female
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 3710 CENTRAL AVE STE 9
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City | KEARNEY
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State | NE
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Zip | 68847-8126
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Country | US
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Telephone | 308-251-2222
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Fax | 308-382-5315
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Provider Business Mailing Address
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Address Line | 2608 OLD FAIR RD
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City | GRAND ISLAND
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State | NE
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Zip | 68803-5271
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Country | US
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Telephone | 308-382-5297
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Fax | 308-382-5315
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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 | 560
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 953
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License Number State | NE
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