Provider Demographics
NPI:1659008050
Name:SHERMAN, MINDI JANICE
Entity Type:Individual
Prefix:
First Name:MINDI
Middle Name:JANICE
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MINDI
Other - Middle Name:JANICE
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3155 SNOW TRILLIUM WAY
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9204
Mailing Address - Country:US
Mailing Address - Phone:720-295-3790
Mailing Address - Fax:877-400-4480
Practice Address - Street 1:3500 JFK PKWY
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2635
Practice Address - Country:US
Practice Address - Phone:720-295-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health