Active NPI
Sandra Sue Pankonin, SOCIAL WORKER
- Social Worker
- Rochester, WI
National Provider Identifier
1417205162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 8603-120
- Practice address
- 206 W. Wade Street
Rochester, WI 53167 - Phone
- (262) 210-5004
- NPI assigned
- Aug 28, 2012
- Last updated
- Aug 28, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 8603-120 | WI | Primary |
Addresses
Primary practice location
206 W. Wade Street
Rochester, WI 53167
Mailing address
206 W. Wade Street
Rochester, WI 53167
Phone (262) 210-5004
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8603-120 | WI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346112000000",
"number": "1417205162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 W. WADE STREET",
"city": "ROCHESTER",
"state": "WI",
"postal_code": "53167",
"telephone_number": "262-210-5004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 W. WADE STREET",
"city": "ROCHESTER",
"state": "WI",
"postal_code": "53167",
"telephone_number": "262-210-5004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANKONIN",
"first_name": "SANDRA",
"middle_name": "SUE",
"name_prefix": "Mrs.",
"credential": "SOCIAL WORKER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-28",
"last_updated": "2012-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WI",
"license": "8603-120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.