Healthcare Provider Details

I. General information

NPI: 1427263847
Provider Name (Legal Business Name): SANDRA LEE WENNER OTR, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HIGHBANKS PL
SAINT CLOUD MN
56301-4408
US

IV. Provider business mailing address

22 HIGHBANKS PL
SAINT CLOUD MN
56301-4408
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-8020
  • Fax:
Mailing address:
  • Phone: 320-252-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number100325
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: