Active NPI
Sandra Ellen Vangilder
- Addiction (Substance Use Disorder) Counselor
- Bloomington, IN
National Provider Identifier
1548988173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 33009441A
- Practice address
- 4555 N Ridgewood Dr
Bloomington, IN 47404-8924 - Phone
- (815) 219-2260
- NPI assigned
- Aug 19, 2022
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 33009441A | IN | Primary |
Addresses
Primary practice location
4555 N Ridgewood Dr
Bloomington, IN 47404-8924
Mailing address
4555 N Ridgewood Dr
Bloomington, IN 47404-8924
Phone (815) 219-2260
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 |
|---|---|---|---|
| 33009441A | IN | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660867200000",
"number": "1548988173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4555 N RIDGEWOOD DR",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474048924",
"telephone_number": "815-219-2260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4555 N RIDGEWOOD DR",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474048924",
"telephone_number": "815-219-2260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANGILDER",
"first_name": "SANDRA",
"middle_name": "ELLEN",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-08-19",
"last_updated": "2022-08-19",
"certification_date": "2022-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IN",
"license": "33009441A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.