Provider Demographics
NPI:1487083754
Name:NEWSOME, SANDY (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3083 EDEN CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8364
Mailing Address - Country:US
Mailing Address - Phone:575-405-7472
Mailing Address - Fax:
Practice Address - Street 1:3083 EDEN CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8364
Practice Address - Country:US
Practice Address - Phone:575-405-7472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2406103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling