Provider Demographics
NPI:1114311925
Name:SANCHEZ, CARRISA
Entity type:Individual
Prefix:
First Name:CARRISA
Middle Name:
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 1:5807 OSBORNE DR W
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-9158
Mailing Address - Country:US
Mailing Address - Phone:402-463-5611
Mailing Address - Fax:308-234-4018
Practice Address - Street 1:5807 OSBORNE DR W
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-9158
Practice Address - Country:US
Practice Address - Phone:402-463-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NE1020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor