Michael P Sanderson, CSAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Phillips, WI
NPI 1104121987 · NPPES record last updated Jan 26, 2011
Key facts
- NPI
- 1104121987
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 246132 (WI)
- Practice address
- 548 N Lake Ave
Phillips, WI 54555-1028 - Phone
- (715) 339-6453
- Fax
- (715) 339-6450
- NPI assigned
- Jan 25, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 246132 | WI | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 246132 | WI | Yes |
Addresses
Primary practice location
548 N Lake Ave
Phillips, WI 54555-1028
Mailing address
548 N Lake Ave
Phillips, WI 54555-1028
Phone (715) 339-6453
Other providers in Phillips, WI
- Roepke Physical Therapy Limited Partnership
- Roepke Physical Therapy Limited Partnership
- Heather R Romatowski
- Roundys Supermarkets Inc
- Nancy Jean Rublee
- John A Satterwhite
- Michelle J Schmidt
- School District of Phillips
- Lori A Severson
- Sport Plus Physical Therapy LLC
All providers in Phillips, WI · Addiction (Substance Use Disorder) Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.