Healthcare Provider Details

I. General information

NPI: 1063400984
Provider Name (Legal Business Name): BROOKE DANIELLE SANDER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26319 HASSMAN DR
AITKIN MN
56431-3232
US

IV. Provider business mailing address

26319 HASSMAN DR
AITKIN MN
56431-3232
US

V. Phone/Fax

Practice location:
  • Phone: 218-839-5258
  • Fax:
Mailing address:
  • Phone: 218-330-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2022
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: