1720243371 NPI number — DR. KATHLEEN A. SANDAL-MILLER PH.D.

Table of content: DR. KATHLEEN A. SANDAL-MILLER PH.D. (NPI 1720243371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720243371 NPI number — DR. KATHLEEN A. SANDAL-MILLER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDAL-MILLER
Provider First Name:
KATHLEEN
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
S.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICENSED PSYCHOLOGIS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1720243371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1057
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80134-1057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-841-0529
Provider Business Mailing Address Fax Number:
720-851-3075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19755 E PIKES PEAK CT
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80138-7414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-841-0529
Provider Business Practice Location Address Fax Number:
720-851-3075
Provider Enumeration Date:
07/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1651 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: COAAA4958 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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