Provider Demographics
NPI:1083746804
Name:TILLSON, SANDRA MARIE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:TILLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 GALAPAGO ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3942
Mailing Address - Country:US
Mailing Address - Phone:303-504-6800
Mailing Address - Fax:303-892-5591
Practice Address - Street 1:1075 GALAPAGO ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3942
Practice Address - Country:US
Practice Address - Phone:303-504-6800
Practice Address - Fax:303-892-5591
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health