Provider Demographics
NPI:1306420914
Name:WILEY, SANDRA DENISE (LMSW-IPR)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DENISE
Last Name:WILEY
Suffix:
Gender:F
Credentials:LMSW-IPR
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:DENISE
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW-IPR
Mailing Address - Street 1:PO BOX 29206
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-0206
Mailing Address - Country:US
Mailing Address - Phone:210-904-4095
Mailing Address - Fax:
Practice Address - Street 1:6410 FIRESTONE PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1544
Practice Address - Country:US
Practice Address - Phone:210-904-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home