Provider Demographics
NPI:1386490274
Name:ICENOGLE, SABLE (MA)
Entity type:Individual
Prefix:
First Name:SABLE
Middle Name:
Last Name:ICENOGLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10549 RACINE WAY
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-6628
Mailing Address - Country:US
Mailing Address - Phone:309-221-6030
Mailing Address - Fax:
Practice Address - Street 1:10549 RACINE WAY
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-6628
Practice Address - Country:US
Practice Address - Phone:309-221-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health