Provider Demographics
NPI:1710507587
Name:SANBORN, JULIAN (PHD, LICSW, SEP)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:SANBORN
Suffix:
Gender:F
Credentials:PHD, LICSW, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 WAYZATA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1316
Mailing Address - Country:US
Mailing Address - Phone:763-432-4071
Mailing Address - Fax:
Practice Address - Street 1:5353 WAYZATA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1316
Practice Address - Country:US
Practice Address - Phone:763-432-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN284251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical