Provider Demographics
NPI:1427263847
Name:WENNER, SANDRA LEE (OTR, CRC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:WENNER
Suffix:
Gender:F
Credentials:OTR, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HIGHBANKS PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4408
Mailing Address - Country:US
Mailing Address - Phone:320-252-8020
Mailing Address - Fax:
Practice Address - Street 1:22 HIGHBANKS PL
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4408
Practice Address - Country:US
Practice Address - Phone:320-252-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X
MN100325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist