Sandra Ann Ckodre, B.A.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CG60150465 Issued in WA

Practice address

1275 2ND Ave SW
Tumwater, WA 98512-6976

Phone

(360) 292-1182

Fax

(360) 292-1184

NPI assigned

Jun 23, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Behavioral Health Resources

  • Mental Illness Community Based Residential Treatment Facility
  • Tumwater, WA
  • NPI 1952532996
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498176000000",
    "number": "1114447885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3857 MARTIN WAY E",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065268",
            "telephone_number": "360-704-7170",
            "fax_number": "360-709-4374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 2ND AVE SW",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985126976",
            "telephone_number": "360-292-1182",
            "fax_number": "360-292-1184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CKODRE",
        "first_name": "SANDRA",
        "middle_name": "ANN",
        "credential": "B.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-23",
        "last_updated": "2017-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "100188",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "CG60150465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100188",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christensen Spine and Wellness, LLC
• Joshua James Christensen, D.C.
• Laurie Virginia Christensen
• Christina Chung, DMD
• Eui Chung, RPH
• Sheelah K Clarke, LMHCA
• Clear Communications NW
• Clear TMS PLLC
• Samantha Dee Clevenger, DC
• Jason Mark Clevenstine

• Mental Health Counselor in Tumwater, WA
• Providers in Tumwater, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.