Provider Demographics
NPI:1225018872
Name:SANCHEZ, STEPHANIE SUZANNE (AUD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUZANNE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:AUD
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 398
Mailing Address - Street 2:
Mailing Address - City:JARALES
Mailing Address - State:NM
Mailing Address - Zip Code:87023-0398
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9500 MONTGOMERY BLVD NE
Practice Address - Street 2:STE. 215
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2501
Practice Address - Country:US
Practice Address - Phone:505-247-4224
Practice Address - Fax:505-247-1772
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3118231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59225289Medicaid