Provider Demographics
NPI:1386368892
Name:IMHOFF, SANDRA J (CSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:IMHOFF
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:J
Other - Last Name:PACKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 KESSEL CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:702 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1424
Practice Address - Country:US
Practice Address - Phone:608-280-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI120-396104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker