Provider Demographics
NPI:1457164055
Name:EMILY P SANDER, PSYD, LLC
Entity type:Organization
Organization Name:EMILY P SANDER, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SANDER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:859-992-2868
Mailing Address - Street 1:827 SNOWBIRD DR
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-7173
Mailing Address - Country:US
Mailing Address - Phone:859-992-2868
Mailing Address - Fax:
Practice Address - Street 1:105 4TH ST E STE 300
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2047
Practice Address - Country:US
Practice Address - Phone:859-992-2868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty