Healthcare Provider Details

I. General information

NPI: 1912504622
Provider Name (Legal Business Name): LYNDI ELISABETH SANDERS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNDI ELISABETH CURRAN

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 14TH ST W STE 290
WILLISTON ND
58801-4078
US

IV. Provider business mailing address

1500 14TH ST W STE 290
WILLISTON ND
58801-4078
US

V. Phone/Fax

Practice location:
  • Phone: 701-334-6242
  • Fax: 701-713-3299
Mailing address:
  • Phone: 701-334-6242
  • Fax: 701-713-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5980
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: