Provider Demographics
NPI:1578667184
Name:SANDAGE, STEVEN JOHN (PH D LP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOHN
Last Name:SANDAGE
Suffix:
Gender:M
Credentials:PH D LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LONG LAKE RD
Mailing Address - Street 2:SUITE 320 ARDEN WOODS PSYCHOLOGICAL SERVICES
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6428
Mailing Address - Country:US
Mailing Address - Phone:651-482-9361
Mailing Address - Fax:651-488-9888
Practice Address - Street 1:900 LONG LAKE RD
Practice Address - Street 2:SUITE 320 ARDEN WOODS PSYCHOLOGICAL SERVICES
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6428
Practice Address - Country:US
Practice Address - Phone:651-482-9361
Practice Address - Fax:651-488-9888
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN 4249103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical