MEDICARE: DR. SANDRA KAY HEWITT PHD

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	103TC2200X	Clinical Child & Adolescent Psychologist	0523	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5946HE	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1669546479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA KAY HEWITT PHD

Provider Business Mailing Address
First Line	:	32 EAGLES NEST CIR
Second Line	:
City	:	HUDSON
State	:	WI
Zip	:	54016-7735
Country	:	US
Telephone Number	:	651-430-2636
Fax Number	:

Provider Business Practice Location Address
First Line	:	570 ASBURY ST
Second Line	:	SUITE 310
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-1849
Country	:	US
Telephone Number	:	651-646-7010
Fax Number	:	651-646-7668

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	01/11/2026

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