Provider Demographics
NPI:1316395148
Name:SANCHEZ, SUSAN GAYLE (ASSOCIATES DEGREE)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GAYLE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:ASSOCIATES DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19347 STATE HIGHWAY 44
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-3757
Mailing Address - Country:US
Mailing Address - Phone:580-471-4425
Mailing Address - Fax:
Practice Address - Street 1:221 W 3RD ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:OK
Practice Address - Zip Code:73651-3603
Practice Address - Country:US
Practice Address - Phone:580-752-4309
Practice Address - Fax:888-573-7792
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator