Provider Demographics
NPI:1588039317
Name:SPERRY, LAURIE (PHD, BCBA-D, MSC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SPERRY
Suffix:
Gender:F
Credentials:PHD, BCBA-D, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 WARD RD
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2124
Mailing Address - Country:US
Mailing Address - Phone:571-451-4380
Mailing Address - Fax:901-250-8631
Practice Address - Street 1:4940 WARD RD
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2124
Practice Address - Country:US
Practice Address - Phone:571-451-4380
Practice Address - Fax:901-250-8631
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-04
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-13-12858103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1033615224Medicaid