Provider Demographics
NPI:1225734791
Name:SANCHEZ, KIERSTEN RENNE
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:RENNE
Last Name:SANCHEZ
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 1:805 LLOYD LN APT B
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-1273
Mailing Address - Country:US
Mailing Address - Phone:512-944-6004
Mailing Address - Fax:
Practice Address - Street 1:1205 SAM BASS RD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4247
Practice Address - Country:US
Practice Address - Phone:512-893-4504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician