Provider Demographics
NPI:1639315385
Name:EGAN-MCNIFF, SANDRA MARIE (LP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MARIE
Last Name:EGAN-MCNIFF
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11860 LOCKRIDGE AVE S
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-8406
Mailing Address - Country:US
Mailing Address - Phone:651-438-2267
Mailing Address - Fax:651-438-9338
Practice Address - Street 1:11860 LOCKRIDGE AVE S
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-8406
Practice Address - Country:US
Practice Address - Phone:651-438-2267
Practice Address - Fax:651-438-9338
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2181103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist