MEDICARE: CAROLYNN SONDA LPC

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
1	101YP2500X	Professional Counselor	21	CO

General Provider Information

NPI Number	:	1902886229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYNN SONDA LPC

Provider Business Mailing Address
First Line	:	2004 N 12TH ST
Second Line	:	SUITE 47
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2982
Country	:	US
Telephone Number	:	970-241-6500
Fax Number	:	970-243-8835

Provider Business Practice Location Address
First Line	:	2004 N 12TH ST
Second Line	:	SUITE 47
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2982
Country	:	US
Telephone Number	:	970-241-6500
Fax Number	:	970-243-8835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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