Provider Demographics
NPI:1881782530
Name:SANDAHL, STEPHANIE A G (MA)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:A G
Last Name:SANDAHL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-4804
Mailing Address - Country:US
Mailing Address - Phone:218-736-5431
Mailing Address - Fax:218-739-4807
Practice Address - Street 1:731 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-4804
Practice Address - Country:US
Practice Address - Phone:218-736-5431
Practice Address - Fax:218-739-4807
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00257101YP2500X
MNCC00369101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional