Individual
MRS. ILYNE SANDAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MALP
Contact information
Practice address
9531 W 78TH ST, 125, EDEN PRAIRIE, MN 55344-3810
(952) 941-2889
(952) 402-9326
Mailing address
8141 MAPLEWOOD TER, CHANHASSEN, MN 55317-9661
(952) 941-2889
(952) 401-9326
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LP3248
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1045950000
—
FM
01
—
22G21SA
BLUE CROSS BLUE SHIELD OF
MN
01
—
62-90595
MEDICA
MN
01
—
81860
HEALTH PARTNERS
MN
01
—
937020
PREFERRED ONE
MN
Enumeration date
10/16/2006
Last updated
07/09/2007
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