Provider Demographics
NPI:1316248057
Name:LANE, SANDRA D (CISW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:D
Last Name:LANE
Suffix:
Gender:F
Credentials:CISW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APSW
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:21 WEST OMAHA STREET
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891-4402
Mailing Address - Country:US
Mailing Address - Phone:715-373-0160
Mailing Address - Fax:715-373-0162
Practice Address - Street 1:21 WEST OMAHA STREET
Practice Address - Street 2:NORTHLAND COUNSELING SERVICES
Practice Address - City:WASHBURN
Practice Address - State:WI
Practice Address - Zip Code:54891-4402
Practice Address - Country:US
Practice Address - Phone:715-373-0160
Practice Address - Fax:715-373-0162
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI993-1221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical