Provider Demographics
NPI:1992533665
Name:HAILESELASSIE, SARON
Entity type:Individual
Prefix:
First Name:SARON
Middle Name:
Last Name:HAILESELASSIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16303 E 49TH AVE APT H106
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-5664
Mailing Address - Country:US
Mailing Address - Phone:720-277-5115
Mailing Address - Fax:
Practice Address - Street 1:16303 E 49TH AVE APT H106
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-5664
Practice Address - Country:US
Practice Address - Phone:720-277-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health