Healthcare Provider Details

I. General information

NPI: 1639802465
Provider Name (Legal Business Name): SONJA NICOLE STANG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 02/19/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 SIENNA DR S STE 107
FARGO ND
58104-8910
US

IV. Provider business mailing address

3175 SIENNA DR S STE 107
FARGO ND
58104-8910
US

V. Phone/Fax

Practice location:
  • Phone: 701-248-6306
  • Fax:
Mailing address:
  • Phone: 701-248-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4260
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: