Basic Information
| Provider Information | |||||||||
| NPI: | 1346203650 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDBERG | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 WEST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705224549 | ||||||||
| FaxNumber: | 9705229544 | ||||||||
| Practice Location | |||||||||
| Address1: | 871 EAST FIRST STREET | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703452254 | ||||||||
| FaxNumber: | 9703452744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2006 | ||||||||
| LastUpdateDate: | 03/05/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW989579 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.