Provider Demographics
NPI:1679516959
Name:BURT, SANDRA LYNN (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LYNN
Last Name:BURT
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1794
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-1794
Mailing Address - Country:US
Mailing Address - Phone:360-376-7119
Mailing Address - Fax:360-376-6182
Practice Address - Street 1:1286 MOUNT BAKER RD
Practice Address - Street 2:SUITE B208
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-8931
Practice Address - Country:US
Practice Address - Phone:360-376-7119
Practice Address - Fax:360-376-6182
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000054691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8935548OtherL & I CRIME VICTIMS COMP
CA365248OtherMANAGED HEALTH NETWORK
WA3452BUOtherREGENCE BLUE SHIELD
CANONEOtherPACIFIC CARE BEHAVIORAL H
WANONEOtherMOLINA HEALTHCARE
WA8854393Medicare ID - Type Unspecified