Provider Demographics
NPI:1295408433
Name:EASTER, SANDRA (MA, PHD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:EASTER
Suffix:
Gender:F
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4507 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-5011
Mailing Address - Country:US
Mailing Address - Phone:805-705-4892
Mailing Address - Fax:
Practice Address - Street 1:4507 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-5011
Practice Address - Country:US
Practice Address - Phone:805-705-4892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0108267103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling