Provider Demographics
NPI:1659539591
Name:PEDIATRIC CONSULTATION SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:PEDIATRIC CONSULTATION SPECIALISTS, PLLC
Other - Org Name:PSYCHOLOGY CONSULTATION SPECIALISTS, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KUPERMAN
Authorized Official - Last Name:SONDELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:763-746-2707
Mailing Address - Street 1:3300 FERNBROOK LANE N
Mailing Address - Street 2:#120
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447
Mailing Address - Country:US
Mailing Address - Phone:763-559-7050
Mailing Address - Fax:763-559-7060
Practice Address - Street 1:3300 FERNBROOK LANE N
Practice Address - Street 2:#120
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447
Practice Address - Country:US
Practice Address - Phone:763-559-7050
Practice Address - Fax:763-559-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4585103TC0700X
103TC0700X, 1041C0700X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty