Healthcare Provider Details

I. General information

NPI: 1881568152
Provider Name (Legal Business Name): SONDER HEALTH PEDIATRIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7825 WASHINGTON AVE S STE 615C
MINNEAPOLIS MN
55439-2430
US

IV. Provider business mailing address

7825 WASHINGTON AVE S STE 615C
MINNEAPOLIS MN
55439-2430
US

V. Phone/Fax

Practice location:
  • Phone: 651-417-6115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CRISSY JACKSON
Title or Position: QUALIFIED SUPERVISING PROFESSIONAL
Credential:
Phone: 651-417-6115