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General NPI Number Information
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NPI Number | 1750611703
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Entity Type | Individual
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Provider Name | SANDRA JEAN JANZEN LPC, CAC III
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Gender | Female
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Dates
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Enumeration Date | 01/13/2010
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 7610 N UNION BLVD STE 145
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3894
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Country | US
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Telephone | 719-290-7339
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 63841
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City | COLORADO SPRINGS
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State | CO
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Zip | 80962-3841
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Country | US
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Telephone | 719-290-7339
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACC-6127
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-3419
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License Number State | CO
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