Provider Demographics
NPI:1306976360
Name:HENDERSON, SANDRA CHRISTINE (LCSW MSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:CHRISTINE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:CHRISTINE
Other - Last Name:COUPAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:1545 S LAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-1924
Mailing Address - Country:US
Mailing Address - Phone:414-671-5920
Mailing Address - Fax:414-645-7850
Practice Address - Street 1:1545 S LAYTON BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1924
Practice Address - Country:US
Practice Address - Phone:414-671-5920
Practice Address - Fax:414-645-7850
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35231231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40963600Medicaid