Basic Information
| Provider Information | |||||||||
| NPI: | 1366635278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANCHEZ | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | GERARD | ||||||||
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| Credential: | LISW, BCD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2286 PALISADE BLVD | ||||||||
| Address2: | |||||||||
| City: | DUPONT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983279786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529683909 | ||||||||
| FaxNumber: | 2539681151 | ||||||||
| Practice Location | |||||||||
| Address1: | MADIGAN ARMY MEDICAL CTR | ||||||||
| Address2: | 9040 A REID ST | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539683909 | ||||||||
| FaxNumber: | 2539691151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 08/18/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I-0665 | NM | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.