Provider Demographics
NPI:1619566544
Name:COLLADO, SANNA INGER (BA)
Entity Type:Individual
Prefix:
First Name:SANNA
Middle Name:INGER
Last Name:COLLADO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:SANNAH
Other - Middle Name:INGER
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6201 PACIFIC AVE STE C3
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-7423
Mailing Address - Country:US
Mailing Address - Phone:253-363-8853
Mailing Address - Fax:
Practice Address - Street 1:6201 PACIFIC AVE STE C3
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7423
Practice Address - Country:US
Practice Address - Phone:253-363-8853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61129223101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor