MEDICARE: MS. SANDRA MCINTOSH LCSW

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	101YM0800X	Mental Health Counselor	004726	MO

General Provider Information

NPI Number	:	1396834008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA MCINTOSH LCSW

Provider Business Mailing Address
First Line	:	400 N WASHINGTON ST
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1716
Country	:	US
Telephone Number	:	573-756-7099
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N WASHINGTON ST
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1716
Country	:	US
Telephone Number	:	573-756-7099
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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