Healthcare Provider Details

I. General information

NPI: 1487915815
Provider Name (Legal Business Name): SONIA BURNS REARDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONIA BURNS

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FREEMAN DR
SAINT PETER MN
56082-3504
US

IV. Provider business mailing address

100 FREEMAN DR
SAINT PETER MN
56082-3504
US

V. Phone/Fax

Practice location:
  • Phone: 612-406-1655
  • Fax:
Mailing address:
  • Phone: 612-406-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberLP6205
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: