Provider Demographics
NPI:1104987080
Name:SANFORD, SANDRA RUTH (MSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:RUTH
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:R
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:209 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:OKEMAH
Mailing Address - State:OK
Mailing Address - Zip Code:74859-2618
Mailing Address - Country:US
Mailing Address - Phone:918-623-2922
Mailing Address - Fax:
Practice Address - Street 1:840 S ASPEN AVE
Practice Address - Street 2:STE E
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4803
Practice Address - Country:US
Practice Address - Phone:918-814-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical