Provider Demographics
NPI:1558049478
Name:SANDBAKKEN, CAROLYNNE (LADC)
Entity Type:Individual
Prefix:
First Name:CAROLYNNE
Middle Name:
Last Name:SANDBAKKEN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:CAROLYNNE
Other - Middle Name:
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2042 WOODDALE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 9TH AVE
Practice Address - Street 2:
Practice Address - City:ST PAUL PARK
Practice Address - State:MN
Practice Address - Zip Code:55071-1436
Practice Address - Country:US
Practice Address - Phone:651-686-0518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)