Provider Demographics
NPI:1750611703
Name:JANZEN, SANDRA JEAN (LPC, CAC III)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:JANZEN
Suffix:
Gender:F
Credentials:LPC, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 63841
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80962-3841
Mailing Address - Country:US
Mailing Address - Phone:719-290-7339
Mailing Address - Fax:
Practice Address - Street 1:7610 N UNION BLVD STE 145
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3894
Practice Address - Country:US
Practice Address - Phone:719-290-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC-6127101YA0400X
COLPC-3419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)