Provider Demographics
NPI:1700317062
Name:SANOW, KIM MARCIA (LMFT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARCIA
Last Name:SANOW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 170TH ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:MN
Mailing Address - Zip Code:56175-2131
Mailing Address - Country:US
Mailing Address - Phone:507-530-3833
Mailing Address - Fax:507-929-4673
Practice Address - Street 1:219 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1471
Practice Address - Country:US
Practice Address - Phone:507-537-4525
Practice Address - Fax:507-929-4673
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3433106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist