Provider Demographics
NPI:1154624245
Name:LASKI, SANDRA JANE (LICSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JANE
Last Name:LASKI
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 1:2867 JAMES AVE S APT 4
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1890
Mailing Address - Country:US
Mailing Address - Phone:612-202-0535
Mailing Address - Fax:
Practice Address - Street 1:2867 JAMES AVE S. SUITE 4
Practice Address - Street 2:305
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-5540
Practice Address - Country:US
Practice Address - Phone:612-202-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302638101YA0400X
MN186221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)