1447357488 NPI number — MS. SANDRA KAY SIMONSON MS, LICSW

Table of content: MS. SANDRA KAY SIMONSON MS, LICSW (NPI 1447357488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447357488 NPI number — MS. SANDRA KAY SIMONSON MS, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMONSON
Provider First Name:
SANDRA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZELLMER
Provider Other First Name:
SANDRA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447357488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 240541
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APPLE VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55124-0541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-997-7961
Provider Business Mailing Address Fax Number:
952-997-7961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
984 ASHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55104-7001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-997-7961
Provider Business Practice Location Address Fax Number:
952-997-7961
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  05961 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 023327700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2177398 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110385 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 530T6SI . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62-71799 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: A60887208767 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".




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