Healthcare Provider Details

I. General information

NPI: 1508988981
Provider Name (Legal Business Name): SANDRA RUTH STREITMAN PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 LILAC DR N STE 115
GOLDEN VALLEY MN
55422-4528
US

IV. Provider business mailing address

9031 W 34TH ST
ST LOUIS PARK MN
55426-3703
US

V. Phone/Fax

Practice location:
  • Phone: 952-457-3795
  • Fax:
Mailing address:
  • Phone: 952-457-3795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP0666
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number311850
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: