Provider Demographics
NPI:1487744918
Name:ADAMS, SANDRA MARIE (PHD, CSAC, ICS)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MARIE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PHD, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W300S10397 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9126
Mailing Address - Country:US
Mailing Address - Phone:262-542-3255
Mailing Address - Fax:
Practice Address - Street 1:16535 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5936
Practice Address - Country:US
Practice Address - Phone:262-542-3255
Practice Address - Fax:262-821-6180
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2042101YA0400X
WI2838123104100000X
WI28381041C0700X
WI5093-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39681200Medicaid
WI39681200Medicaid