MEDICARE: ELISE M SANDERS L.I.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	17215	MN

General Provider Information

NPI Number	:	1447471768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE M SANDERS L.I.C.S.W.

Provider Business Mailing Address
First Line	:	6101 ZENITH AVE S
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55410-2839
Country	:	US
Telephone Number	:	612-718-3828
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 ZENITH AVE S
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55410-2839
Country	:	US
Telephone Number	:	612-718-3828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	03/12/2025

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