| Doctor Name: | MS. KIMBERLY ANN SANDUSKY |
| NPI Number: | 1144525197 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 000081 |
| Business Practice Address: | 1853 Oconnell Blvd Bldg 1056 Fort Carson, CO - 809134055 |
| Business Phone Number: | 7195266748 |
| Business Fax Number: | |
| Mailing Address: | 990 Bayfield Way, #201 COLORADO SPRINGS |
| State: | CO |
| Postal Code: | 809064627 |
| Phone Number: | 7193573072 |
| Fax Number: | |
| NPI Enumeration Date: | 01/24/2011 |
| NPI Last Update Date: | 01/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 000081 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GU |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |