Provider Demographics
NPI:1417968207
Name:SONDELL, SANDRA KUPERMAN (PHD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KUPERMAN
Last Name:SONDELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 HARBOR LN N
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5109
Mailing Address - Country:US
Mailing Address - Phone:763-559-7050
Mailing Address - Fax:
Practice Address - Street 1:3021 HARBOR LN N
Practice Address - Street 2:SUITE 210
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5109
Practice Address - Country:US
Practice Address - Phone:763-559-7050
Practice Address - Fax:763-559-7060
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical