Provider Demographics
NPI:1447357488
Name:SIMONSON, SANDRA KAY (MS, LICSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:KAY
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:MS, LICSW
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:KAY
Other - Last Name:ZELLMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 240541
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-0541
Mailing Address - Country:US
Mailing Address - Phone:952-997-7961
Mailing Address - Fax:952-997-7961
Practice Address - Street 1:984 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-7001
Practice Address - Country:US
Practice Address - Phone:952-997-7961
Practice Address - Fax:952-997-7961
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN059611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN023327700Medicaid
2177398OtherCIGNA
110385OtherHEALTHPARTNERS
530T6SIOtherBLUE CROSS BLUE SHIELD
62-71799OtherUNITED BEHAVIORAL HEALTH
A60887208767OtherPREFERREDONE