Healthcare Provider Details

I. General information

NPI: 1114353349
Provider Name (Legal Business Name): SANDY KAISER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 REDTAIL HAWK DR
ESTES PARK CO
80517-9780
US

IV. Provider business mailing address

125 CRESTRIDGE ST
FORT COLLINS CO
80525-3934
US

V. Phone/Fax

Practice location:
  • Phone: 970-586-9105
  • Fax:
Mailing address:
  • Phone: 970-494-9761
  • Fax: 970-300-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: