Basic Information
Provider Information
NPI: 1003011727
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANCHEZ
FirstName: STEPHANIE
MiddleName: DIANE
NamePrefix: MISS
NameSuffix:  
Credential: MSW, LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 240 N TILLOTSON AVE
Address2:  
City: MUNCIE
State: IN
PostalCode: 473043988
CountryCode: US
TelephoneNumber: (765) 288-1928
FaxNumber: 7657410335
Practice Location
Address1: 2506 WILLOWBROOK PKWY STE 300
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462051500
CountryCode: US
TelephoneNumber: 3175741254
FaxNumber: 3176740060
Other Information
ProviderEnumerationDate: 06/21/2007
LastUpdateDate: 08/10/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X34006378AINY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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