Provider Demographics
NPI:1700641198
Name:SONTAG, EMILY (LAC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SONTAG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 BROADWAY ST NE STE 250
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-3082
Mailing Address - Country:US
Mailing Address - Phone:612-339-5088
Mailing Address - Fax:
Practice Address - Street 1:2112 BROADWAY ST NE STE 250
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-3082
Practice Address - Country:US
Practice Address - Phone:612-339-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2062171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist