Provider Demographics
NPI:1164517710
Name:SANCHEZ-JOHNSEN, LISA ANNE PUALANI (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE PUALANI
Last Name:SANCHEZ-JOHNSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:A P
Other - Last Name:JOHNSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:N2251 WILDERLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4464
Mailing Address - Country:US
Mailing Address - Phone:773-266-0012
Mailing Address - Fax:
Practice Address - Street 1:N2251 WILDERLAND DR
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4464
Practice Address - Country:US
Practice Address - Phone:262-729-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3993-57103T00000X
IL071006666103TC0700X
HI855103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical