MEDICARE: IESHA V SANDERS LPC

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	6077-125	WI
2	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962923276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IESHA V SANDERS LPC

Provider Business Mailing Address
First Line	:	9000 W WISCONSIN AVE # MS 958
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-4874
Country	:	US
Telephone Number	:	414-266-7615
Fax Number	:	414-266-6238

Provider Business Practice Location Address
First Line	:	7720 W GOOD HOPE RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-4516
Country	:	US
Telephone Number	:	414-536-0236
Fax Number	:	414-536-0260

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

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	03/23/2022

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Directions to “ IESHA V SANDERS LPC” Practice Location

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