Provider Demographics
NPI:1457483885
Name:SANDSTROM, MARIANNE (MA)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:SANDSTROM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6083 ANNAPURNA DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-5313
Mailing Address - Country:US
Mailing Address - Phone:719-580-0808
Mailing Address - Fax:303-456-0607
Practice Address - Street 1:4891 INDEPENDENCE ST STE 165
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6714
Practice Address - Country:US
Practice Address - Phone:303-456-0600
Practice Address - Fax:303-456-0607
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health