Provider Demographics
NPI:1922631381
Name:SANCHEZ, SECADIO
Entity Type:Individual
Prefix:
First Name:SECADIO
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S 200 E STE 250
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3846
Mailing Address - Country:US
Mailing Address - Phone:801-359-2256
Mailing Address - Fax:
Practice Address - Street 1:716 E 4500 S STE N160
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3617
Practice Address - Country:US
Practice Address - Phone:801-281-1100
Practice Address - Fax:801-281-1936
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
UT7769454-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator