Provider Demographics
NPI:1356426696
Name:SQUICQUERO, SANDI YVONNE (LPC)
Entity type:Individual
Prefix:
First Name:SANDI
Middle Name:YVONNE
Last Name:SQUICQUERO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 MAIN ST
Mailing Address - Street 2:#5B
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4709
Mailing Address - Country:US
Mailing Address - Phone:970-674-0191
Mailing Address - Fax:970-674-0221
Practice Address - Street 1:1180 MAIN ST
Practice Address - Street 2:#5B
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4709
Practice Address - Country:US
Practice Address - Phone:970-674-0191
Practice Address - Fax:970-674-0221
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health