Provider Demographics
NPI:1245550029
Name:SANCHEZ, LISA MARIE (CA-SLP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:CA-SLP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:MADDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCC-SLP
Mailing Address - Street 1:552 DOLPHIN DR.
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044
Mailing Address - Country:US
Mailing Address - Phone:650-922-4726
Mailing Address - Fax:
Practice Address - Street 1:99 VIEWMONT AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-2955
Practice Address - Country:US
Practice Address - Phone:408-661-8643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11854OtherSLP