Provider Demographics
NPI:1538719760
Name:FOLKERTS, SANDRA LEE (LMSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:FOLKERTS
Suffix:
Gender:F
Credentials:LMSW
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 233
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638-0233
Mailing Address - Country:US
Mailing Address - Phone:800-531-4236
Mailing Address - Fax:319-483-6661
Practice Address - Street 1:604 8TH ST
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638-1328
Practice Address - Country:US
Practice Address - Phone:800-531-4236
Practice Address - Fax:319-483-6661
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06322104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker