Provider Demographics
NPI:1962524678
Name:FIELDS NEAL, SANDRA L (MSW CSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:FIELDS NEAL
Suffix:
Gender:F
Credentials:MSW CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 S BURDICK ST
Mailing Address - Street 2:SUITE 254
Mailing Address - City:KALAMAZOO
Mailing Address - State:MS
Mailing Address - Zip Code:49007
Mailing Address - Country:US
Mailing Address - Phone:269-381-5213
Mailing Address - Fax:269-381-4375
Practice Address - Street 1:535 S BURDICK ST
Practice Address - Street 2:SUITE 254
Practice Address - City:KALAMAZOO
Practice Address - State:MS
Practice Address - Zip Code:49007
Practice Address - Country:US
Practice Address - Phone:269-381-5213
Practice Address - Fax:269-381-4375
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010595011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI126282OtherVALUE OPTIONS
MI0890743OtherBCBS
MI0890743OtherBCBS