Provider Demographics
NPI:1740738921
Name:SANDSTROM, TYLEEN IRENE (BSW)
Entity Type:Individual
Prefix:
First Name:TYLEEN
Middle Name:IRENE
Last Name:SANDSTROM
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 S PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2886
Mailing Address - Country:US
Mailing Address - Phone:719-564-5070
Mailing Address - Fax:719-896-2874
Practice Address - Street 1:2429 S PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2886
Practice Address - Country:US
Practice Address - Phone:719-564-5070
Practice Address - Fax:719-896-2874
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker