Provider Demographics
NPI:1053127043
Name:SUDMALIS, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:SUDMALIS
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 1:29751 SPRUCE RD LOWR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-2601
Mailing Address - Country:US
Mailing Address - Phone:720-978-2044
Mailing Address - Fax:
Practice Address - Street 1:29751 SPRUCE RD LOWR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2601
Practice Address - Country:US
Practice Address - Phone:720-978-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002972101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)