Provider Demographics
NPI:1841800141
Name:ARDOIN, SAMANTHA LUISA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LUISA
Last Name:ARDOIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-2520
Mailing Address - Country:US
Mailing Address - Phone:571-420-2864
Mailing Address - Fax:
Practice Address - Street 1:2850 MCCLELLAND DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2586
Practice Address - Country:US
Practice Address - Phone:970-636-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health