Provider Demographics
NPI:1699512475
Name:SANSOM, KARLI RAE
Entity type:Individual
Prefix:
First Name:KARLI
Middle Name:RAE
Last Name:SANSOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-2406
Mailing Address - Country:US
Mailing Address - Phone:360-589-4261
Mailing Address - Fax:
Practice Address - Street 1:110 W MARKET ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6206
Practice Address - Country:US
Practice Address - Phone:360-523-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator