Provider Demographics
NPI:1295975225
Name:RICKERTSEN, SANDRA LYNN (MS LMFT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:RICKERTSEN
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 W SHORE DR SW
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-6740
Mailing Address - Country:US
Mailing Address - Phone:763-245-1970
Mailing Address - Fax:
Practice Address - Street 1:1150 W SHORE DR SW
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-6740
Practice Address - Country:US
Practice Address - Phone:763-245-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2183106H00000X, 106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist