Jacques, Sandra
Jacques, Sandra is an individual health care provider with primary practice located at 121 W Main St Suite 350, Port Washington WI 53074-1813. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Jacques, Sandra can be contacted via phone (262) 284-8130.Contact Information
Primary practice address
121 W Main St Suite 350
Port Washington WI 53074-1813
Phone: (262) 284-8130
Fax: (262) 284-8104
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 548123 | Wisconsin |
Profile Details
| NPI number | 1154312544 |
|---|---|
| LBN Legal business name | Jacques, Sandra |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 3rd, 2005 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154312544 | NPPES |
| Wisconsin | MEDICAID | 39246300 |
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