MEDICARE: AMY R SANDOW LMHCA, LICSWA, SUDPT

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	SC61192477	WA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CO61134799	WA
3	101YM0800X	Mental Health Counselor	MC61151125	WA

General Provider Information

NPI Number	:	1164183901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY R SANDOW LMHCA, LICSWA, SUDPT

Provider Business Mailing Address
First Line	:	11414 N ROCKAWAY DR
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-2744
Country	:	US
Telephone Number	:	509-939-3661
Fax Number	:

Provider Business Practice Location Address
First Line	:	11414 N ROCKAWAY DR
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-2744
Country	:	US
Telephone Number	:	509-939-3661
Fax Number	:

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

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	01/04/2022

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