Provider Demographics
NPI:1679386734
Name:BLACKTHORN ANDERSSON, KRISTOFFER III (DD)
Entity type:Individual
Prefix:DR
First Name:KRISTOFFER
Middle Name:
Last Name:BLACKTHORN ANDERSSON
Suffix:III
Gender:M
Credentials:DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1098
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-1098
Mailing Address - Country:US
Mailing Address - Phone:720-930-7260
Mailing Address - Fax:
Practice Address - Street 1:408 VALLEY HI CIR UNIT A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-2693
Practice Address - Country:US
Practice Address - Phone:720-400-5240
Practice Address - Fax:720-400-5240
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral