Provider Demographics
NPI:1053087452
Name:SANCHEZ, SAMANTHA KAY (LMSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KAY
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:KAY
Other - Last Name:SHACKELFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1503 LEGEND TRAIL DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2535
Mailing Address - Country:US
Mailing Address - Phone:785-550-9517
Mailing Address - Fax:
Practice Address - Street 1:901 KENTUCKY ST STE 306
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2858
Practice Address - Country:US
Practice Address - Phone:785-550-9517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12318104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker