Healthcare Provider Details

I. General information

NPI: 1669876405
Provider Name (Legal Business Name): MRS. SANDRA KAYE DEUTSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA KAYE JOHNSON MSW

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 OLEARY LN
EAGAN MN
55123-2340
US

IV. Provider business mailing address

7956 172ND ST W
LAKEVILLE MN
55044-9129
US

V. Phone/Fax

Practice location:
  • Phone: 651-454-0114
  • Fax: 651-454-3492
Mailing address:
  • Phone: 952-431-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12927
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: