Individual
MRS. SANDRA S BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2790 N ACADEMY BLVD, STE 206, COLORADO SPRINGS, CO 80917
(719) 596-1530
(719) 559-1130
Mailing address
2790 N ACADEMY BLVD, STE 206, COLORADO SPRINGS, CO 80917
(719) 596-1530
(719) 559-1130
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
989473
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
076866
—
CO
Enumeration date
02/27/2007
Last updated
07/08/2007
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