Provider Demographics
NPI:1194028837
Name:ROSE, SANDRA JO ALBERT
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JO ALBERT
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JO
Other - Last Name:ALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0040
Mailing Address - Country:US
Mailing Address - Phone:970-945-2241
Mailing Address - Fax:970-945-5523
Practice Address - Street 1:249 EAST EAGLE RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620
Practice Address - Country:US
Practice Address - Phone:970-328-8666
Practice Address - Fax:970-328-8666
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor