Provider Demographics
NPI:1992743355
Name:DROBNICK, SANDRA LOU (LPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LOU
Last Name:DROBNICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 NORTH BEAUMONT ROAD
Mailing Address - Street 2:SUITE 326
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-1445
Mailing Address - Country:US
Mailing Address - Phone:608-326-0248
Mailing Address - Fax:608-326-4395
Practice Address - Street 1:225 N BEAUMONT RD
Practice Address - Street 2:SUITE 326
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-1445
Practice Address - Country:US
Practice Address - Phone:608-326-0248
Practice Address - Fax:608-326-4395
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI903-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39218900Medicaid
WI241791OtherMIDLAND CHOICE