Provider Demographics
NPI:1215164322
Name:SEWELL, SANDY RUBY (LICSW, CMHS)
Entity type:Individual
Prefix:MS
First Name:SANDY
Middle Name:RUBY
Last Name:SEWELL
Suffix:
Gender:F
Credentials:LICSW, CMHS
Other - Prefix:MS
Other - First Name:SANDY
Other - Middle Name:RUBY
Other - Last Name:SEWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW, CMHS
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-0091
Mailing Address - Country:US
Mailing Address - Phone:360-607-6017
Mailing Address - Fax:360-750-1374
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:STE 214
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3402
Practice Address - Country:US
Practice Address - Phone:360-607-6017
Practice Address - Fax:360-750-1374
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW60271794OtherLICSW