Healthcare Provider Details

I. General information

NPI: 1306321534
Provider Name (Legal Business Name): ANGELICA NOEMI SANCHEZ BS SLP-ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SAINT LOUIS AVE STE 102
FORT WORTH TX
76104-3377
US

IV. Provider business mailing address

815 WOODARD AVE APT 624
CLEBURNE TX
76033-7019
US

V. Phone/Fax

Practice location:
  • Phone: 817-921-5020
  • Fax:
Mailing address:
  • Phone: 956-280-8185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number38117
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: