Provider Demographics
NPI:1124305651
Name:LINDGREN, SANDRA J (LICSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:LINDGREN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3203
Mailing Address - Country:US
Mailing Address - Phone:612-827-5657
Mailing Address - Fax:
Practice Address - Street 1:7380 FRANCE AVE S STE 209
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4546
Practice Address - Country:US
Practice Address - Phone:952-835-6540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical