Provider Demographics
NPI:1134797582
Name:THEDIN, SAMANTHA (PHD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:THEDIN
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:SAMANTHA
Other - Last Name:ENGLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3345 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1909
Mailing Address - Country:US
Mailing Address - Phone:303-500-3407
Mailing Address - Fax:
Practice Address - Street 1:3345 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1909
Practice Address - Country:US
Practice Address - Phone:303-500-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-13
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6233103TC2200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent