MEDICARE: MS. SANDRA S CARLSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SO2434	TX

General Provider Information

NPI Number	:	1023162377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA S CARLSON

Provider Business Mailing Address
First Line	:	8303 BO JACK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-1534
Country	:	US
Telephone Number	:	713-896-8813
Fax Number	:	713-937-4879

Provider Business Practice Location Address
First Line	:	4119 MONTROSE BLVD
Second Line	:	SUITE 450
City	:	HOUSTON
State	:	TX
Zip	:	77006-4963
Country	:	US
Telephone Number	:	713-522-3700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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