Provider Demographics
NPI:1710125653
Name:LESTER, SANDRA W (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:W
Last Name:LESTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:W
Other - Last Name:LESTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:5320 FLATROCK PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-7921
Mailing Address - Country:US
Mailing Address - Phone:719-322-6770
Mailing Address - Fax:719-687-8881
Practice Address - Street 1:3462 BRIARGATE BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4168
Practice Address - Country:US
Practice Address - Phone:719-322-6770
Practice Address - Fax:719-687-8881
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003394103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA100292Medicare PIN