Provider Demographics
NPI:1538580147
Name:DAVIDSON, SANDRA ELIZABETH
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:ELIZABETH
Other - Last Name:WIRKKALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 1337
Mailing Address - Street 2:6926 N.E. FOURTH PLAIN BLVD.
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-1337
Mailing Address - Country:US
Mailing Address - Phone:360-993-3000
Mailing Address - Fax:
Practice Address - Street 1:18 NW 20TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4175
Practice Address - Country:US
Practice Address - Phone:360-597-9731
Practice Address - Fax:360-597-9732
Is Sole Proprietor?:No
Enumeration Date:2013-12-27
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW604113831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical