Provider Demographics
NPI:1215563630
Name:CANION, SARAH MICHELLE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MICHELLE
Last Name:CANION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1087
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-1087
Mailing Address - Country:US
Mailing Address - Phone:505-634-8236
Mailing Address - Fax:
Practice Address - Street 1:63 ROAD 3050
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-9637
Practice Address - Country:US
Practice Address - Phone:505-634-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician