Provider Demographics
NPI:1962749614
Name:GASKILL, SANDRA L (MS, EDS, LPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:GASKILL
Suffix:
Gender:F
Credentials:MS, EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-0838
Mailing Address - Country:US
Mailing Address - Phone:303-579-7330
Mailing Address - Fax:
Practice Address - Street 1:1445 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-0838
Practice Address - Country:US
Practice Address - Phone:303-579-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional