Provider Demographics
NPI:1417076068
Name:THORNE, SANDRA D (MS)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:D
Last Name:THORNE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:DOMASK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PSYCHOLOGIST
Mailing Address - Street 1:7760 FRANCE AVE S
Mailing Address - Street 2:OFFICE 1118
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5800
Mailing Address - Country:US
Mailing Address - Phone:952-886-7275
Mailing Address - Fax:952-886-7273
Practice Address - Street 1:7760 FRANCE AVE S
Practice Address - Street 2:OFFICE 1118
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5800
Practice Address - Country:US
Practice Address - Phone:952-886-7275
Practice Address - Fax:952-886-7273
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1894103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN552053300Medicaid
MN552053300Medicaid