Provider Demographics
NPI:1669546479
Name:HEWITT, SANDRA KAY (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:KAY
Last Name:HEWITT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 EAGLES NEST CIR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7735
Mailing Address - Country:US
Mailing Address - Phone:651-430-2636
Mailing Address - Fax:
Practice Address - Street 1:570 ASBURY ST
Practice Address - Street 2:SUITE 310
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1849
Practice Address - Country:US
Practice Address - Phone:651-646-7010
Practice Address - Fax:651-646-7668
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0523103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5946HEOtherBCBS