Provider Demographics
NPI:1447030440
Name:LEE, SONYA JEAN (LGSW)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:JEAN
Last Name:LEE
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SUMTER AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4001
Mailing Address - Country:US
Mailing Address - Phone:952-999-1852
Mailing Address - Fax:
Practice Address - Street 1:7525 KALLAND AVE NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55301-9690
Practice Address - Country:US
Practice Address - Phone:763-428-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306931041S0200X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool