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NPI Code Detail

MEDICARE: MS. MARIANNE SANDSTROM MA

MEDICARE: MS. MARIANNE SANDSTROM MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor2839CO

General Provider Information

NPI Number : 1457483885
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIANNE SANDSTROM MA
Provider Business Mailing Address
First Line : 6083 ANNAPURNA DR
Second Line :
City : EVERGREEN
State : CO
Zip : 80439-5313
Country : US
Telephone Number : 719-580-0808
Fax Number : 303-456-0607
Provider Business Practice Location Address
First Line : 4891 INDEPENDENCE ST STE 165
Second Line :
City : WHEAT RIDGE
State : CO
Zip : 80033-6714
Country : US
Telephone Number : 303-456-0600
Fax Number : 303-456-0607
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 01/15/2018

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