Provider Demographics
NPI:1174291579
Name:SANCHEZ, SANDRA MAY (LMSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MAY
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 STACE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5202
Mailing Address - Country:US
Mailing Address - Phone:208-534-8618
Mailing Address - Fax:
Practice Address - Street 1:2185 STACE ST APT 3
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-5202
Practice Address - Country:US
Practice Address - Phone:208-534-8618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-409121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty