Provider Demographics
NPI:1174998348
Name:STENERSON, SANDRA JEAN
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:STENERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:14781 81ST AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2153
Mailing Address - Country:US
Mailing Address - Phone:612-385-1839
Mailing Address - Fax:
Practice Address - Street 1:9827 MAPLE GROVE PKWY N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4491
Practice Address - Country:US
Practice Address - Phone:952-993-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist