Provider Demographics
NPI:1801087424
Name:THIBDEAU, SAGE ELIZABETH (PA)
Entity type:Individual
Prefix:MRS
First Name:SAGE
Middle Name:ELIZABETH
Last Name:THIBDEAU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 W 173RD PL
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-5202
Mailing Address - Country:US
Mailing Address - Phone:720-618-7098
Mailing Address - Fax:
Practice Address - Street 1:698 BRIGGS ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516
Practice Address - Country:US
Practice Address - Phone:720-618-7098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3267103TC2200X, 363AM0700X, 363A00000X
NY011930363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical