Provider Demographics
NPI:1861549081
Name:GRATTON, SANDRA SUE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:SUE
Last Name:GRATTON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W ROE ST
Mailing Address - Street 2:
Mailing Address - City:OSSIAN
Mailing Address - State:IN
Mailing Address - Zip Code:46777-9397
Mailing Address - Country:US
Mailing Address - Phone:260-622-7997
Mailing Address - Fax:260-622-6678
Practice Address - Street 1:107 W ROE ST
Practice Address - Street 2:
Practice Address - City:OSSIAN
Practice Address - State:IN
Practice Address - Zip Code:46777-9397
Practice Address - Country:US
Practice Address - Phone:260-622-7997
Practice Address - Fax:260-622-6678
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003380A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN186420Medicare PIN