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General NPI Number Information
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NPI Number | 1780553925
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Entity Type | Organization
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Legal Business Name | SANDSTED WELLNESS LLC
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 20855 KENSINGTON BLVD STE B201
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City | LAKEVILLE
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State | MN
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Zip | 55044-7542
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Country | US
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Telephone | 612-812-1875
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 ALOHA AVE
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City | SHAKOPEE
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State | MN
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Zip | 55379-7732
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA SANDER WOMELDORF
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Credential | LADC, LPCC
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Telephone | 612-812-1875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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