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General NPI Number Information
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NPI Number | 1194258608
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Entity Type | Individual
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Provider Name | SANDY GURULE LSW
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Gender | Female
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 115 CEDAR STREET
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City | IGNACIO
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State | CO
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Zip | 88137
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Country | US
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Telephone | 970-563-9388
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Fax |
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Provider Business Mailing Address
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Address Line | 3118 COUNTY ROAD 307
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City | DURANGO
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State | CO
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Zip | 81303-6881
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Country | US
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Telephone | 970-749-1744
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW 00000335
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License Number State | CO
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