Provider Demographics
NPI:1679322242
Name:KARL, SANDGREN BURGESS DINKEL
Entity type:Individual
Prefix:
First Name:SANDGREN
Middle Name:BURGESS DINKEL
Last Name:KARL
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 1:1110 S DOVER ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5247
Mailing Address - Country:US
Mailing Address - Phone:773-706-8782
Mailing Address - Fax:
Practice Address - Street 1:1110 S DOVER ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5247
Practice Address - Country:US
Practice Address - Phone:773-706-8782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019733101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health