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General NPI Number Information
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NPI Number | 1790820280
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Entity Type | Individual
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Provider Name | SANDY RAE JUNG PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 720 E 33RD STREET
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City | MINNEAPOLIS
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State | MN
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Zip | 55407
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Country | US
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Telephone | 952-974-9797
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Fax |
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Provider Business Mailing Address
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Address Line | 14865 BLAKENEY RD
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City | EDEN PRAIRIE
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State | MN
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Zip | 55347-5312
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Country | US
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Telephone | 952-974-9797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | CC00101
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CC00101
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License Number State | MN
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