Healthcare Provider Details

I. General information

NPI: 1720936552
Provider Name (Legal Business Name): SARA FENSTERMACHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 NORTH RD
CIRCLE PINES MN
55014-1545
US

IV. Provider business mailing address

4707 NORTH RD
CIRCLE PINES MN
55014-1545
US

V. Phone/Fax

Practice location:
  • Phone: 763-792-6000
  • Fax:
Mailing address:
  • Phone: 763-792-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: