Individual
DR. SANDRA SUE SMITH HANEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EDD
Contact information
Practice address
4323 E LAKE ST, MINNEAPOLIS, MN 55406-2307
(612) 722-1003
(612) 721-6336
Mailing address
4323 E LAKE ST, MINNEAPOLIS, MN 55406-2307
(612) 722-1003
(612) 721-6336
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2754
MN
103TA0700X
Adult Development & Aging Psychologist
LP2754
MN
103TB0200X
Cognitive & Behavioral Psychologist
LP2754
MN
103TC1900X
Counseling Psychologist
LP2754
MN
103TF0000X
Family Psychologist
LP2754
MN
103TF0200X
Forensic Psychologist
LP2754
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
064925M
BCBS
MN
01
—
100479
UCARE
MN
05
—
432747100
—
MN
01
—
6180090
MEDICA
MN
Enumeration date
09/21/2006
Last updated
03/12/2014
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