Sandra M Vandomelen, SAC-IT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

15463-130 Issued in WI

Practice address

9415 W Forest Home Ave
Suite #1
Hales Corners, WI 53130-1680

Phone

(414) 427-4884

NPI assigned

Apr 4, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1207267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207267200000",
    "number": "1225201817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4555 W SCHROEDER DR",
            "address_2": "SUITE 170",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532231475",
            "telephone_number": "414-365-3210",
            "fax_number": "414-365-3225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9415 W FOREST HOME AVE",
            "address_2": "SUITE #1",
            "city": "HALES CORNERS",
            "state": "WI",
            "postal_code": "531301680",
            "telephone_number": "414-427-4884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDOMELEN",
        "first_name": "SANDRA",
        "middle_name": "M",
        "credential": "SAC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-04",
        "last_updated": "2008-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "15463-130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas E. Raimann DDS
• David Francis Timmer, M.S.W.
• Jennifer Marie Tralongo, OTR
• Susan Tubic
• Cassandra Ann Van Kleunen, D.D.S.
• Jordan Vandyck, DPT
• Village of Hales Corners
• Village of Hales Corners
• Walgreen Co
• Mark Wanezek

• Addiction (Substance Use Disorder) Counselor in Hales Corners, WI
• Providers in Hales Corners, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2008; 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.