Provider Demographics
NPI:1821019043
Name:STERNHAGEN, SCOTT V (PHD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:V
Last Name:STERNHAGEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 UNIVERSITY DR N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4661
Mailing Address - Country:US
Mailing Address - Phone:701-566-5272
Mailing Address - Fax:
Practice Address - Street 1:112 UNIVERSITY DR N
Practice Address - Street 2:SUITE 200
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4661
Practice Address - Country:US
Practice Address - Phone:701-566-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND239103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17790Medicaid
ND17790Medicaid