Provider Demographics
NPI:1700212818
Name:LANZ, SANDRA M (LSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:LANZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 19TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-8899
Mailing Address - Country:US
Mailing Address - Phone:701-852-3628
Mailing Address - Fax:701-852-1190
Practice Address - Street 1:6301 19TH AVE NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-8899
Practice Address - Country:US
Practice Address - Phone:701-852-3628
Practice Address - Fax:701-852-1190
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2901104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker