Provider Demographics
NPI:1891250163
Name:SANDKAMP, PATRICIA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SANDKAMP
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8419 178TH LN NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MN
Mailing Address - Zip Code:55025-8351
Mailing Address - Country:US
Mailing Address - Phone:651-332-0897
Mailing Address - Fax:
Practice Address - Street 1:3833 COON RAPIDS BLVD NW STE 120
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2599
Practice Address - Country:US
Practice Address - Phone:763-767-3350
Practice Address - Fax:763-767-0912
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3567106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist