Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 3300 | CO |
N | 103TC0700X | Clinical Psychologist | 3300 | CO |
Y | 103TH0004X | Health Psychologist | 3300 | CO |
NPI | 1003238296 |
---|---|
Provider Name | Dr. Sandra Thebaud |
First Address | Denver, CO 80217 |
Second Address | Denver, CO 80206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2014 |
Last Update Date | 08/01/2014 |