Healthcare Provider Details

I. General information

NPI: 1770990806
Provider Name (Legal Business Name): KAREN SANCHEZ STAEDLER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3134 PACIFIC AVE
STOCKTON CA
95204-3640
US

IV. Provider business mailing address

3134 PACIFIC AVE
STOCKTON CA
95204-3640
US

V. Phone/Fax

Practice location:
  • Phone: 209-910-3383
  • Fax: 866-256-0351
Mailing address:
  • Phone: 209-910-3383
  • Fax: 866-256-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number06241
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: