Provider Demographics
NPI:1881035624
Name:SANDRA STREITMAN PLLC
Entity Type:Organization
Organization Name:SANDRA STREITMAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:STREITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:952-935-3152
Mailing Address - Street 1:9031 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3703
Mailing Address - Country:US
Mailing Address - Phone:952-935-3152
Mailing Address - Fax:195-251-6595
Practice Address - Street 1:9031 W 34TH ST
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3703
Practice Address - Country:US
Practice Address - Phone:952-935-3152
Practice Address - Fax:195-251-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0666261QD1600X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0000377722Medicaid