Provider Demographics
NPI:1942171046
Name:WISECARVER, SANDY ANNETTE
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:ANNETTE
Last Name:WISECARVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 RENE CT
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9513
Mailing Address - Country:US
Mailing Address - Phone:360-595-4821
Mailing Address - Fax:
Practice Address - Street 1:105 3RD ST
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1408
Practice Address - Country:US
Practice Address - Phone:360-389-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-13
Last Update Date:2025-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC70034740104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker