Healthcare Provider Details

I. General information

NPI: 1669651535
Provider Name (Legal Business Name): JESSICA A SANCHEZ MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MAIN ST STE 249
LAS CRUCES NM
88001-1206
US

IV. Provider business mailing address

505 S MAIN ST STE 249
LAS CRUCES NM
88001-1206
US

V. Phone/Fax

Practice location:
  • Phone: 505-527-5823
  • Fax: 505-527-5886
Mailing address:
  • Phone: 505-527-5823
  • Fax: 505-527-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberC-4223
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP4435
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: